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THE  LIBRARY  OF  THE 
UNIVERSITY  OF 
NORTH  CAROLINA 
AT  CHAPEL  HILL 


ENDOWED  BY  THE 
DIALECTIC  AND  PHILANTHROPIC 
SOCIETIES 


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♦W53 


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00001  86551  0 


This  book  is  due  at  the  LOUIS  R.  WILSON  LIBRARY  on  the 
last  date  stamped  under  “Date  Due.”  If  not  on  hold  it  may  be 
renewed  by  bringing  it  to  the  library. 

DATE  nrT 

DUE 

DATE 

DUE  KtI* 

NOV  1  7  1988 

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Form  No.  513  ' 

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Bougereau, 


ANTICIPATION 


* 


TOCOLOGY  FOR  MOTHERS: 


J\  medical  Guide 

I 


THE 

■w  53 


TO  THE  CARE  OF  THEIR  HEALTH  AND 

l 

MANAGEMENT  OF  CHILDREN. 


WESTLAND, 


BT 


AMERICAN  REPRINT  EDITION 
PREPARED  FOR  PUBLICATION  WITH  ILLUSTRATIONS, 


E.  B.  FOOTE,  Jr.,  M.  0. 


NEW  YORK  : 

MURRAY  HILL  PUBLISHING  COMPANY, 

129  EAST  28TH  STREET. 

1901, 


COPYRIGHT,  1900,  B\  £.  B.  TOOTH,  K.O> 


I 


La  Barre,  Printer,  106  East  28rtt  Street.,  New  Yore, 


PUBLISHER’S  PREFACE. 


FOR  THE  AMERICAN  EDITION. 

The  subjects  treated  in  the  following  pages  are  essential  to  a  complete  family- 
medical  cyclopedia,  and  as  Dr.  Foote’s  writings  have  not  covered  this  ground  we 
have  heretofore  offered  our  customers  the  well  known  and  deservedly  popular  books 
by  Dr.  Chavasse,  for  wives  and  mothers,  but  the  plates  of  our  last  editions  show 
rather  too  much  wear,  and  the  work  needed  revision  as  well  as  resetting.  In  get¬ 
ting  up  a  new  book  we  have,  for  several  reasons,  preferred  to  adopt  Dr.  Westland’s 
and  adapt  it  to  the  American  reader.  It  is  less  discursive  than  that  of  Chavasse, 
or,  as  we  say,  “  more  to  the  point.”  It  was  very  recently  written,  is  well-balanced, 
“well  put,”  and  up-to-date.  As  the  author  says  in  his  preface,  “  the  information 
is  the  common  property  of  every  well-educated  physician  ;  ”  but  its  presentation 
in  a  clear,  readable,  and  suitable  shape  for  the  ordinary  reader  is  not  a  task  that 
all  physicians  could  do  equally  well.  Dr.  Westland’s  work  is  not  “flowery”  or 
sentimental,  but  it  is  thoroughly  practical,  and  well  within  the  easy  comprehension 
of  any  reader  of  good  English.  To  those  having  immediate  personal  interest  in 
matters  relating  to  maternity,  it  must  be  of  great  service  both  for  occasional  refer¬ 
ence  and  as  a  book  for  study. 

Tocology  means  a  discourse  on  parturition  or  child-bearing,  and  on  this  subject 
there  are  three  classes  of  books  needed.  Physicians  in  that  line  of  practice  should 
of  course  know  it  all,  and  their  technical  text-books  embrace  a  great  amount  of 
material  which  is  necessary  only  for  them.  Books  on  nursing  of  women  during 
confinement  are  prepared  so  as  to  instruct  nurses  in  their  special  work  and  duties. 

Lastly,  there  is  a  good  deal  of  knowledge  that  should  be  possessed  by  every 
woman  who  is  about  to  become  a  mother,  because  it  will  save  her  much  discom¬ 
fort  during  gestation,  much  suffering  in  labor,  and  help  to  prevent  accidents  and 
complications  which  should  always  be  avoided  when  possible.  Dr.  Westland  has 
well  selected  and  presented  his  advice  with  the  sole  purpose  of  making  it  an 
acceptable  and  useful  Tocology  for  Mothers,  and  besides  instructing  them  in 
the  ways  and  means  toward  safe  and  painless  childbirth,  he  has  added  such  instruc¬ 
tion  for  motherhood  and  the  care  of  infants  and  children  as  should  enable  happy 
mothers  to  successfully  raise  the  tender  products  of  their  love  and  labor. 

We  therefore  commend  this  work  to  every  mother,  and  every  woman  who 
expects  to  become  a  mother.  Of  course  millions  of  babies  have  been  born  to  and 
successfully  raised  by  mothers,  who  have  little  more  than  love,  instinct,  and  home 
customs  to  guide  them,  but  knowledge  is,  after  all,  the  best  reliance,  and  a  large 
part  of  the  present  excessive  mortality  of  infants  and  the  accompanying  floods  of 
mother’s  tears  might  be  avoided  if  every  prospective  mother  would  read,  digest, 
and  become  familiar  with  the  instructions  offered  them  in  this  book. 

Where  the  reviewing  editor  of  this  American  edition  has  thought  best  to 
materially  modify  the  original  text  or  interpolate  new  matter,  it  is  included  in 
brackets,  [  ]  in  order  that  the  author  may  be  protected  from  misrepresentation 

or  being  made  to  say  what  he  did  not. 


& 


E.  B.  FOOTE,  Jb, 


AUTHOR’S  PREFACE. 


This  work  is  addressed  to  women  who  are  desirous  of  fulfilling  properly  their 
duties  as  wives  and  mothers,  and  is  designed  to  assist  them  in  exercising  an  intel¬ 
ligent  supervision  over  their  own  and  their  children’s  health.  The  information 
contained  in  it  is  the  common  property  of  every  well-educated  physician ;  any 
difficulty  which  has  presented  itself  in  its  composition  has  arisen  in  the  selection 
of  the  contents,  and  their  mode  of  treatment.  In  these  respects  the  author  has 
been  guided  by  his  experience  in  general  medical  practice,  his  object  having  been 
to  convey  as  much  information  as  an  intelligent  woman  might  be  expected  to 
appreciate  and  utilize. 

In  the  chapter  on  Common  Maladies  of  Children,  systematic  description  of 
diseases  has  been  avoided,  the  intention  of  the  author  being  rather  to  give  such 
general  information  of  their  character  and  course  as  would  assist  in  their  recog¬ 
nition,  and  afford  some  guide  to  their  management. 

ALBERT  WESTLAND. 

London. 


t  .  - 


* 


LIST  OF  CONTENTS. 


PART  I. 


EARLY  HARRIED  LIFE. 


CHAPTER  I. 

PAGE 

Duties  and  Responsibilities  of  Married  Life .  H 

.Ignorance  before  Marriage  of  Probable  Duties  and  Responsibilities;  Impor 
tance  of  Step  taken  in  entering  Matrimony;  Necessity  of  Mutual  Self-Sacri¬ 
fice;  Probability  ot  Maternity;  Period  of  Life  during  which  Maternity  may 
Occur;  Possibility  of  some  Suffering  during  this  Period  ;  Effect  of  Mother’s 
Life  and  Conduct  on  Future  Health  of  Child  ;  Inherited  Tendencies  ;  Les¬ 
sons  from  Examples  ;  Imitative  Faculties  of  Children. 

CHAPTER  II. 

Altered  Conditions  of  t.ife  after  Marriage .  15 

Change  in  the  Circumstances  of  the  Wife;  Loss  of  Family  Ties;  Formation  of 
New  Friendships;  Utilization  of  Leisure  Hours;  Importance  of  Out-door 
Exercise;  Various  Forms  of  Exercise;  Value  of  Motive  in  Walking;  Care 
in  Diet;  Duty  of  Taking  Proper  Care  of  Health;  Place  of  Alcoholic  Stimu¬ 
lants  in  Diet;  Injurious  Effects  of  Improper  Use  of  Stimulants  on  Mother 
and  Child;  Mental  Occupation;  Tendency  to  Occasional  Depression; 
Methods  of  Relief;  Domestic  Troubles;  Rule  for  Avoiding  Worry. 

CHAPTER  III. 

Signs  and  Symptoms  of  Pregnancy .  1® 

Their  Existence  and  Import;  Plan  of  Consideration;  Cessation  of  Menstrua¬ 
tion;  Its  Significance  and  Value  in  Determining  Probable  Duration  of  Preg¬ 
nancy;  Normal  Duration  of  Pregnancy;  Extreme  Limits  of  Duration; 
Methods  of  Determining  Probable  Date  of  Confinement;  Examples.  Gas¬ 
tric  Derangements;  Morning  Sickness;  Abnormal  Sense  of  Hunger;  Crav¬ 
ing  for  Unusual  Articles  of  Diet;  Pain  in  Stomach;  Other  Disorders  of  Di¬ 
gestion.  Enlargement  of  Breasts;  Tenderness;  Prominence  of  Veins; 
Secretion  of  Milk;  Enlargement  and  Pigmentation  of  Areola;  Secondary 
Areola;  Quickening  and  Sensations  of  Movement  of  Child;  Possibility  of 
Mistake  in  Sensations;  External  Evidence  of  Movement;  Increase  in  Size 

of  Abdomen;  Period  at  which  Noticeable;  Conclusion. 

5 


6 


LIST  OP  CONTENTS, 


CHAPTER  IV. 

PAGE 

Management  of  Unpleasant  Disorders  of  Pregnancy .  29 

Nausea  and  Sickness;  Alleviation  by  Tea;  Breakfast  in  Bed;  Effervescing 
Drinks;  Care  in  Diet;  Heartburn;  Temporary  Means  of  Relief;  Water 
Brash;  Dietary  for  Disorders  of  Digestion  in  Pregnancy;  Constipation; 
Alleviation  by  Diet;  Regular  Habits;  Drugs;  Warm  Water;  Mineral 
Waters;  Salts;  Sulphur;  Licorice  Powder;  Senna;  Enemas;  Method  of 
Administration;  Injection  of  Glycerine;  Special  Syringe  desirable;  Selec¬ 
tion  of  Remedy;  Faintness;  Remedies;  Caution  respecting  Stimulants;  In¬ 
crease  in  Size  and  Sense  of  Weight;  Arrangement  of  Clothing;  Use  of  Cor¬ 
sets;  Supporting  Belts;  Stretching  of  Skin  of  Abdomen  and  Breasts;  Cause; 
Results;  Pigmentation;  Prevention;  Alleviation;  Swelling  of  Feet  and 
Legs;  Alleviation;  Distention  of  Veins  of  Legs;  Two  Forms;  Description; 
Hereditary  Tendency;  Treatment;  Piles,  Internal  and  External;  Treat¬ 
ment;  Vaginal  Discharge  and  Irritation;  Alleviation;  Use  of  Injections; 
Precautions;  Bathing;  Sleeplessness;  Causes;  Remedies;  Caution  against 
Use  of  Narcotics. 


CHAPTER  V, 

Miscarriage,  its  Causes,  Risks,  Prevention,  and  Management .  . 44 

Definition  of  Miscarriage ;  Usual  Periods  of  Occurrence;  Earlier  Miscarriages; 
Difficulty  of  Recognition;  Necessity  of  Care  after  their  Occurrence;  Cause 
of  Miscarriage;  Indications  of  Threatened  Miscarriage;  Discharge  of 
Blood;  Pain;  Preventive  Treatment;  Rest;  Coolness;  Light  Diet;  Indica¬ 
tions  for  Medical  Aid;  Necessity  of  Patience;  Symptoms  of  Inevitable  Mis¬ 
carriage;  Description  of  Abortion;  Indications  of  Complete  Removal;  Re¬ 
sults  of  Incomplete  Removal;  Convalescence  from  Miscarriage;  Necessity 
of  Rest;  Value  of  Syringing;  Preparation  of  Lotions;  Diet  during  Conva¬ 
lescence!  Occasional  Discomfort  of  Breasts;  Final  Remarks. 

CHAPTER  VI, 


Premature  Confinement .  50 

Definition;  Causes;  Recognition  of  Cause ;  Cause  of  Premature  Confinement ; 
Importance  of  Prevention;  Effects  of  Premature  Birth  on  Child  and  on 
Mother;  Necessity  of  Care  in  Later  Months  of  Pregnancy;  Signs  of  Im¬ 
pending  Confinement;  Recurring  Attacks  of  Pain;  Distinction  from  Colic; 
Precautions  Necessary;  Baby  Incubators. 


CHAPTER  VII, 

Preparations  for  Confinement .  61 

Selection  of  Doctor  and  Nurse;  Arrangements  Regarding  Fees;  Advantages 
of  Personal  Interview  with  Monthly  Nurse;  Selection  of  Room;  Drainage 
of  House;  Accommodation  of  Nurse;  Furniture  of  Room ;  Bed-Pan;  Bed- 
Bath;  The  Family  Syringe;  Douche;  Sponges;  Sanitary  Towels;  Binders; 
Antiseptic  Fluids;  Carbolized  Vdseline;  Baby’s  Bath;  Soap;  Baby’s  Dia¬ 
pers;  Bassinette;  Baby’s  Basket;  Its  Contents;  Waterproof  Sheeting; 
Arrangement  of  Bed;  Attention  to  Regular  Action  of  Bowels. 


LIST  OF  CONTENTS. 


7 


CHAPTER  VIII. 

PAGE 

Confinement .  70 

Definition;  Indications  of  Commencement;  Painful  Contractions  of  Womb; 
Frequency;  Distinction  from  “ False  Pains ”;  the  Show;  Demeanor  dur¬ 
ing  First  Stage;  Propriety  of  Laxative  Medicine;  Food;  Transition  from 
“  First  Stage  ”  to  “  Second  Stage  Description  of  Contents  of  Womb,  and 
of  Action  during  Labor;  Bursting  of  the  Waters;  Second  Stage;  Differing 
Character  of  Pains;  Position  of  Mother;  Termination  of  Second  Stage; 
Position  of  Child;  Management  in  Absence  of  Skilled  Assistance;  Third 
Stage;  General  Remarks. 


PART  II. 


EARLY  MOTHERHOOD. 


CHAPTER  IX. 

Convalescence  from  Confinement . . . . . .  76 

Normal  Progress  after  Confinement;  Necessity  of  Quietude;  Injurious  Effects 
of  Excitement;  After-pains;  Diet  after  Confinement;  Occasional  Occur¬ 
rence  of  Sickness;  Aperients;  Discharge;  Occasional  Excess  of  Discharge; 
Management;  Necessity  of  Cleanliness;  Methods  of  Douching  and  Syring¬ 
ing;  Maintenance  of  Recumbent  Position;  Summary  of  Normal  Progress; 
Application  of  Binder;  Alteration  of  Figure  after  Confinement;  Desquama¬ 
tion  of  Skin;  Deepening  of  Color  of  Hair;  Occasional  Occurrence  of  Fever¬ 
ishness;  Necessity  of  Medical  Aid;  Susceptibility  to  Infection  during 
Convalescence. 

CHAPTER  X. 

The  Mother  in  Relation  to  the  Infant . . . . . .  86 

Duty  of  Mother  to  Suckle  Infant;  Occasional  Exceptions;  Normal  Secretion 
of  Milk;  Importance  of  Commencing  Suckling  soon  after  Confinement;  Pro¬ 
cess  of  Sucking;  Flatness  of  Nipple;  Management;  Breast-Pump;  Employ¬ 
ment  of  Older  Baby:  Soreness  of  Nipple;  Fissures  of  Nipple;  Fulness  of 
Breasts;  Insufficient  Flow  of  Milk;  Methods  of  Increasing  Flow;  Frequency 
of  Sucking;  Indications  of  Discomfort  of  Baby;  Probable  Meaning;  Ten¬ 
dency  to  Painful  Digestion;  Susceptibility  of  Infant  to  Improper  Piet  and 
Drugs  taken  by  Mother;  Tension  of  Breasts;  Localized  Hardnegs  and 
Swelling;  Abscess  of  Breast;  Relation  to  Fissures;  Importance  of  Cleanli¬ 
ness;  Objects  of  Treatment;  Question  of  giving  up  Nursing;  Normal  Dona¬ 
tion  of  Nursing;  Indications  pointing  to  Propriety  of  Cessation;  Symptoms 
due  to  Over-nursing— Relief  of  Symptoms;  Arrest  of  Secretion  of  Milk; 
General  Treatment;  Local  Applications. 


I 


8 


LIST  OP  CONTENTS 


PART  III. 


THE  CHILD. 


CHAPTER  XI. 

PAGE 

Normal  Development  op  the  Child .  108 

Average  Size  and  Weight  at  Birth;  Variations;  Description  of  Skin;  Of  Head; 
Sutures  of  Head;  Fontanelles;  Cry;  Grasp;  Animal  Heat;  Necessity  of 
Warmth;  Tendency  to  Sleep;  Action  of  Bowels  and  Kidneys;  Meconium; 
Normal  Excretion  of  Bowels;  Secretion  of  Kidneys;  Indication  of  Disorder; 
Recurring  Craving  for  Food;  Average  Rate  of  Growth  in  Height  and 
Weight;  Increase  in  Intelligence;  Development  of  Sight  and  Hearing; 
Tears  and  Smiles;  Amount  of  Sleep;  Process  of  Teething;  Development  of 
Walking  Powers;  Art  of  Speech;  Second  Dentition;  Absorption  of  First 
Teeth;  Puberty  in  Girls ;  Menstruation;  Occasional  Discomfort;  Necessity 
of  Care  during  Period;  Caution  in  Use  of  Stimulants;  Manifestations  of 
Mental  and  Moral  Disorder;  Puberty  in  Boys;  Nervous  Derangements. 

CHAPTER  XII. 

General  Care  op  the  Child . .  120 

Washing  of  Baby;  Temperature  of  Water;  Soaps;  Use  of  Oil;  Attention  to 
Cord;  Dress;  Necessity  of  avoiding  Pressure  or  Restraint;  Material  of 
Clothing;  Diapers;  Bassinette;  Objection  to  Baby  Sleeping  with  Mother; 
Desquamation  of  Skin;  Red-Gum;  Value  of  Fresh  Air;  Sunshine;  Daily 
Baths;  Value  of  Douching;  Out-Door  Exercise;  Carriage  in  Arms;  Bassin¬ 
ette  Perambulators;  Importance  of  Support  when  sitting  up;  Walking  in 
Open  Air;  Cultivation  of  Cleanly  Habits;  Selection  of  Clothing;  Unreliable¬ 
ness  of  Children’s  Sense  of  Temperature;  Indications  of  Insufficient  Cloth¬ 
ing;  Change  of  Underclothing  at  Night;  Importance  of  Looseness  of 
Clothing. 

CHAPTER  XIII. 

The  Nutrition  op  the  Child .  135 

Mother’s  Milk  the  Natural  Food;  Temporary  Substitute  when  Necessary ; 
Difficulties  of  Sucking;  Frequency;  Amount  of  Milk  obtained;  Use  of  one 
~  or  both  Breasts;  Indications  of  Discomfort  from  Excess  of  Milk  taken; 
Progress  of  Natural  Nursing;  Insufficiency  of  Supply  of  Milk;  Necessity  of 
Artificial  Supplement;  Eligible  Substitutes;  Use  of  Feeding-bottle;  Tem¬ 
perature  of  Artificial  Food;  Farinaceous  Foods;  Selection;  Quantity  to  be 
given;  Occasional  Inability  to  digest  diluted  Cow’s  Milk;  Alternatives; 
Milk  Humanized;  Sterilized;  Peptonized;  Asses’ Milk;  Goats’ Milk;  Wet- 
nurse;  Addition  of  Farinaceous  Food;  Feeding  by  Spoon;  Addition  of 
Animal  Food;  Objections  to  Nerve-stimulants;  Common  Errors  in  Diet  of 
Infants;  Deficiency  of  Fat;  Excess  of  Farinaceous  Food;  Excess  of  Nitro¬ 
genous  Food;  Irritability  of  Digestive  Organs  in  Children. 


LIST  OF  CONTENTS. 


9 


CHAPTER  XIV. 

PAGE 

Physical  and  Mental  Training  of  the  Child .  156 

Object  aimed  at;  Necessity  of  Training  Faculties;  Results  of  Disuse;  Relation 
between  Body  and  Mind ;  Importance  of  Maintenance  of  Health  and  Devel¬ 
opment  of  Function;  Variations  in  Different  Children  due  to  Want  of 
Training;  Dread  of  Undue  Strain;  Value  of  Effort  alternating  with  Rest; 
Necessity  of  Care  against  unduly  Severe  or  Prolonged  Strain;  Spontaneous 
Tendency  to  Movement;  Artificial  Means  of  Exercise;  Swinging;  Military 
Drill;  Musical  Calisthenics;  Dancing;  Importance  of  Regularity  in  Exer¬ 
cise;  Necessity  of  Due  Rest;  Training  of  Special  Senses;  Mental  Training; 
Risk  of  Overwork;  Relation  between  Fatigue  and  Want  of  Interest;  Moral 
Training. 


CHAPTER  XV. 

Some  Congenital  Defects  in  Children .  162 

“Mothers’  Marks”;  Cause;  Treatment;  Club-Foot;  Hair-Lip;  Supernumer¬ 
ary  Fingers  and  Toes;  Hernia:  Umbilical,  Inguinal;  Hernia  in  Middle  Line 
of  Abdomen;  Imperforate  Lachrymal  Ducts;  Liability  to  be  Mistaken  for 
Inflammation;  Imperfections  of  Sight;  Short-sight;  Long-sight;  Astigma¬ 
tism;  Squinting;  Curability;  Detection  of  Short-sight;  Of  Astigmatism. 

CHAPTER  XVI. 

Hints  on  Nursing  Children  during  Illness .  168 

Duties  of  a  Nurse;  Observation  of  the  Patient;  Respiration;  Pulse;  Tempera¬ 
ture;  The  Clinical  Thermometer;  Hygiene  of  Sick-room;  Cleanliness;  Ven¬ 
tilation,  Temperature;  Light  and  Sunshine;  Hygiene  of  Invalid:  Cleanli¬ 
ness;  Clothing;  Food;  Administration  and  Application  of  Remedial 
Agents;  Mixtures;  Powders;  External  Applications;  Warm  Fomentations; 
Spongio-piliue;  Poultices:  Linseed  Poultice,  Bread  Poultice,  Starch  Poul¬ 
tice;  Application  of  Dry  Heat,  of  Cold;  Compresses;  Counter-irritation; 
Stimulating  Liniments;  Mustard  Plasters;  Poultices;  Turpentine  Stoups; 
Medicated  Applications;  Sedative  Liniments;  Ointments;  Lotions;  Syring¬ 
ing  of  Ears;  Applications  to  Throat;  Leeches  :  Management  of  Infectious 
Diseases;  Disinfectants;  Their  Abuse. 


CHAPTER  XVII. 

Some  Minor  Troubles  of  the  Earlier  Months  of  Infant  Life .  192 

Separation  of  Stump  of  Umbilical  Cord;  Occasional  Ulceration ;  Treatment; 
Hernia  at  Navel;  Management;  Inflammation  of  Breasts;  Desquamation 
of  Skin;  Red-Gum;  Jaundice;  Yellow-Gum;  Thrush:  Its  Cause  and 
Treatment;  Diarrhoea;  Its  Causes  and  Treatment;  Erythema  and  Inter¬ 
trigo;  Sand  or  Gravel;  Constipation:  Its  Treatment;  Inflammation  of  Eye¬ 
lids;  Method  of  Applying  Lotions  to  Eye;  Closure  of  Lachrymal  Ducts; 
v  -  Vaccination. 


IO 


LIST  OF  CONTENTS. 


CHAPTER  XVIII. 

PACK 

Some  Disorders  Associated  with  the  Process  or  Dentition..... . .  210 

Condition  of  Nervous  System  during  Dentition;  Difference  of  Manifestations 
in  First  and  Second  Dentitions;  Affections  of  Gums  and  Mouth;  Ulcers  of 
Mouth;  Distinction  from  Thrush;  Feverish  Attacks ;  Restlessness  at  Night; 
Disorders  of  Digestion;  Treatment;  Colic  and  Diarrhoea;  Cold  and  Cough ; 
False  Croup;  Bronchial  Catarrh;  Necessity  of  Care;  Treatment  of  Cold, 
of  False  Croup,  of  Bronchitis;  Child-crowing,  Treatment;  General  Con¬ 
vulsions,  Treatment;  Abscess  of  Ear;  Treatment;  Night  Terrors;  Other 
Mental  Peculiarities. 

CHAPTER  XIX. 

Common  Maladies  or  Children .  221 

1.  Earache  and  Discharge  from  Ear.  2.  Affections  of  Throat;  Catarrhal  In¬ 
flammation  of  Throat;  Subacute  Tonsillitis;  Diphtheritic  Inflammation; 
Distinction  between  them ;  Treatment  of  Catarrhal  Inflammation,  of  Sub¬ 
acute  Tonsillitis;  Precautions  Relating  to  Diphtheria;  Chronic  Enlargement 
of  Tonsils;  Their  Effects  on  Respiration;  Snoring.  3.  Disorders  due  to 
Cold  or  Chill;  Cold  in  the  Head,  in  Throat  and  Larynx;  Bronchitis;  Cold 
affecting  the  Stomach  and  the  Bowels.  4.  Disorders  of  the  Digestive  Or¬ 
gans;  Indigestion,  Acute  and  Chronic;  Diarrhoea;  Prolapse  of  Bowel; 
Constipation;  Treatment  by  Diet,  by  Injections,  by  Medicines.  5.  Erup¬ 
tions  on  the  Skin:  Heat-spots;  Roseola;  Nettle-Rash;  Eczema.  6.  Infec¬ 
tious  Eruptive  Fevers:  Chicken-pox;  Small-pox;  Scarlet  Fever;  Measles; 
Rotheln;  Mumps;  Whooping-Cough;  Responsibility  of  Parents  in  Relation 
to  Infectious  Diseases.  7.  Parasitic  Diseases:  Ringworm;  Itch;  Thread¬ 
worms.  §.  Diathetic  Diseases;  Rheumatism;  Scrofula;  Rickets. 

CHAPTER  XX. 

Management  of  Some  Emergencies .  275 

Bruises;  Sprains;  Burns  and  Scalds;  Incised  Wounds;  Arrest  of  Bleeding; 
Lacerated  Wounds;  Foreign  Bodies  in  Eye;  Foreign  Bodies  in  Ear  and 
Nose;  Bleeding  from  Nose;  Emergency  Basket;  Contents. 


PART  IV. 


LATER  MARRIED  LIFE. 


CHAPTER  XXI. 

The  Menopause .  282 

Change  of  Life;  Age  at  which  it  Occurs;  Manner  of  Occurrence;  Discomforts 
attending  Menopause;  Affections  of  Head;  of  Digestion;  Mental  Irrita¬ 
bility;  Depression  of  Spirits;  Physical  Alterations;  Occasional  “Flood¬ 
ings”;  Treatment  of  Various  Symptoms. 

Index .  S85 


COURTSHIP 


* ) 


TOCOLOGY  FOR  MOTHERS. 


PART  I. 

EARLY  MARRIED  LIFE. 


CHAPTER  I. 

Duties  and  Responsibilities  of  Married  Life. 

Ignorance  before  Marriage  of  Probable  Duties  and  Responsibilities;  Impor- 
v."nce  of  Step  taken  in  entering  Matrimony;  Necessity  of  Mutual  Self-Sacri¬ 
fice;  Probability  of  Maternity;  Period  of  Life  during  which  Maternity  may 
Occur  ;  Possibility  of  some  Suffering  during  this  Period  ;  Effect  of  Mother’s 
Life  and  Conduct  on  Future  Health  of  Child  ;  Inherited  Tendencies  ;  Les¬ 
sons  from  Examples  ;  Imitative  Faculties  of  Children. 

Every  young  woman  who  enters  into  what  are  conventionally 
called  the  “bonds  of  matrimony  ”  voluntarily  accepts  certain  responsi¬ 
bilities,  and  undertakes  certain  duties,  not  only  important  in  them¬ 
selves,  but  noteworthy  also  in  this,  that  their  neglect  and  repudiation 
may  be  followed  by  far-reaching  consequences  to  others.  Convention 
has  decreed  that  those  duties  and  responsibilities  should  be  discovered 
mainly  by  wives  after  marriage  ;  and  it  is  seldom  indeed  that  mothers 
are  judicious  or  enlightened  enough  to  place  before  their  marriageable 
daughters  even  a  partial  view  of  the  difficulties  and  troubles  which 
almost  every  married  woman  will  have  to  face  at  some  period  of  her 
married  life.  Not  that  one  would  wish  such  difficulties  to  be  repre¬ 
sented  as  a  deterrent  from  entering  a  life  which  to  every  woman  should 
form  the  ideal  of  happiness  ;  but  it  is  certainly  desirable  that  women 
on  entering  married  life  should  be  aware  that  calls  will  be  made  upon 
their  courage,  their  temper,  and  their  forbearance  ;  and  should  take 
what  is  undoubtedly  the  most  decisive  step  of  their  lives  with  some 
knowledge  of  its  importance  and  gravity,  and  some  sense  of  the  great 

influence  which  marriage  must  exercise  on  all  their  future  career. 

11 


12 


EARLY  MARRIED  LIFE. 


Whatever  view  one  may  take  of  the  relative  position  of  the  sexes  in 
married  life,  it  is  obvious  that  both  husband  and  wife  must,  to  some 
extent,  lose  the  independence  of  the  unmarried  state.  The  law  of  Eng¬ 
land,  as  of  most  other  civilized  nations,  makes  the  marriage  union 
indissoluble  except  by  death  or  misconduct ;  and  married  people  must 
enter  their  common  life  with  the  full  intention  of  remaining  in  close 
association  for  the  term  of  their  natural  lives.  If  this  association  is  to 
be  a  happy  and  prosperous  one,  if  their  joint  life  is  to  be  fuller  and 
richer  after  marriage  than  before,  it  is  absolutely  essential  that  each 
must  contribute  to  the  result  by  careful  consideration  of  the  other’s 
feelings  and  wishes,  and  by  occasional  sacrifice  of  his  or  her  own  incli¬ 
nation  and  desires.  No  two  human  beings  ever  wTere  born,  or  probably 
ever  will  be,  with  exactly  the  same  tastes,  wishes,  desires,  and  appe¬ 
tites,  just  as  no  twTo  persons  ever  presented  exactly  the  same  type  of 
features  and  expression,  and  if  two  agree  to  lead  the  same  life  as 
united  in  marriage,  that  life  must  naturally  be  to  some  extent  a  com¬ 
promise  of  their  relative  inclinations  and  ideals.  One  of  the  first  duties, 
then,  of  married  life  is  to  learn  to  subordinate  personal  wishes  to 
mutual  interests. 

In  the  marriage  ceremony  of  the  Church  of  England,  it  is  stated 
that  one  of  the  objects  for  which  marriage  is  instituted  is  the  begetting 
of  children  ;  and  to  most,  if  not  all,  right-minded  women,  the  pleasures 
of  maternity  are  looked  forward  to  as  the  highest  blessing  of  married 
life.  There  is  inborn  in  a  woman’s  mind  the  love  of  children,  and  the 
wish  to  have  children  of  her  own,  on  whom  maternal  love  can  be  lav¬ 
ished  ;  and  as  regards  the  vast  majority  of  married  women,  this  instinct 
and  wish  are  fulfilled.  For  the  larger  part  of  a  woman’s  life,  the 
power  of  reproducing  is  possessed  while  in  health,  and  not  unfrequently 
even  when  health  is  much  impaired  ;  and  during  the  whole  period  of 
life  from  fourteen  to  fifty-four  the  possibility  of  bearing  children 
exists,  although  examples  at  either  of  these  extreme  ages  are  very  rare. 
In  England,  where  early  marriage  is  not  the  rule,  it  is  unusual  to  find 
mothers  at  an  earlier  age  than  eighteen,  while  it  is  almost  equally 
exceptional  for  women  to  have  children  after  forty-six  years  of  age. 

Great,  howmver,  as  is  the  pleasure  and  the  comfort  of  possessing 
children,  and  valuable  as  is  the  solace  of  their  love  and  affection,  their 
possession  is  not  usually  attained  without  some  suffering  and  self-sacri¬ 
fice  on  the  part  of  the  mother.  From  the  very  commencement  of  preg¬ 
nancy,  it  is  necessary  for  the  future  mother  to  pay  some  attention  to 
the  results  which  her  life  and  conduct  may  have  on  the  welfare  of  the 
child  she  is  about  to  bring  into  existence.  Irresistible  evidence  is  plen¬ 
tiful  that  both  the  physical  and  mental  health  of  children  depend 
greatly  upon  the  characteristics  which  they  inherit  from  their  parents, 
and  perhaps  more  especially  from  their  mothers.  To  mention  only  very 


EARLY  MARRIED  LIFE. 


13 


well-marked  inherited  tendencies,  it  is  a  matter  of  daily  observation 
that  undue  indulgence  in  alcoholic  beverages  shows  its  effects  in  chil¬ 
dren — not  only  in  a  craving  for  alcohol,  but  also  in  various  diseases  of 
the  nervous  system,  such  as  epilepsy  and  hysteria,  and  even  idiocy. 

No  diseases  are  more  readily  transmitted  to  children  than  those  of 
the  nervous  system  ;  and  want  of  control  in  the  mother,  resulting  in  fits 
of  passion  and  hysterical  attacks,  may  not  unfrequently  manifest  them¬ 
selves  in  children  in  the  more  marked  forms  of  epilepsy  and  insanity. 
So  that  the  duty  of  all  thoughtful  persons  likely  to  become  mothers  is 
indicated  most  plainly.  Careful  regulation  of  daily  life,  abstinence 
from  excesses  of  any  kind,  and,  as  far  as  possible,  the  avoidance  of 
severe  strains  upon  the. nervous  system,  are  of  the  greatest  possible  im¬ 
portance  in  view  of  the  object  most  desired  by  a  right-minded  wife — 
the  bearing  of  a  healthy  infant. 

But  not  only  by  these  more  obvious  and  prominent  departures 
from  healthy  life  is  the  future  of  a  child  imperilled.  There  can  be 
little  doubt  that  even  slighter  ailments  which  may  be  acquired  by  the 
mother  are  sometimes  transmitted  to  the  child.  It  is  not  uncommon 
to  remark  in  children  a  tendency  to  indigestion  and  irritation  of  the 
stomach,  which  may  be  traced  to  the  presence  of  dyspepsia  in  the 
mother,  induced  by  improper  diet  and  undue  indulgence  in  indigestible 
foods.  One  of  the  most  fatal  inheritances  of  children  in  any  country  is 
the  tendency  to  rheumatism,  which  often  leads  in  early  life  to  inflam¬ 
matory  diseases  of  the  heart,  as  well  as  to  painful  affections  of  the 
joints.  Illnesses  of  this  character  in  childhood  frequently  produce 
results  of  which  the  injurious  effects  are  apparent  throughout  the  whole 
duration  of  life  ;  and  even  such  apparently  unimportant  defects  as 
slight  imperfections  of  the  eyes,  showing  themselves  in  short-sighted¬ 
ness  or  long-sightedness,  seem  capable  of  being  transmitted  to  one’s 
offspring.  It  seems  probable,  indeed,  that  minor  mental  imperfections 
— such  as  irritability,  and  angry  passion,  and  deceit — may  be  trans¬ 
mitted  in  a  similar  manner,  although  the  proof  is  more  difficult ;  and 
the  probability  is  strengthened  by  consideration  of  the  frequency  with 
which  tricks  of  manner,  and  peculiarities  of  expression,  are  repeated  in 
children  even  where  the  possibility  of  imitation  has  been  excluded  by 
separation. 

Thoughtful  consideration  of  these  facts  will  impress  upon  every 
married  woman  the  responsibility  which  rests  upon  her  to  regulate  her 
conduct  and  life  in  such  a  way  that  her  offspring  may  not  suffer  in  any 
manner  from  her  indiscretion  or  carelessness.  To  any  one  possessing  a 
sense  of  right  feeling,  it  would  be  a  matter  of  life-long  regret  that  a 
child  has  suffered  from  any  cause  which  a  little  care  exercised  at  the 
proper  time  might  have  entirely  prevented  ;  and  the  remorse  would  be 
intensified  by  the  consideration  that  inherited  taints  of  the  character 


14 


EARLY  MARRIED  LIFE. 


indicated  do  not  necessarily  limit  themselves  to  one  generation,  but 
may  not  unfrequently  be  traced  through  three  or  four  successive 
families. 

The  position  of  responsibility,  moreover,  does  not  end  with  the 
birth  of  the  child.  Although  there  is  room  for  doubt  whether  any 
mental  characteristics  are  actually  absorbed,  in  the  popular  phrase, 
“with  the  mother’s  milk,”  there  can  be  no  doubt  that,  from  a  very 
early  stage  in  its  career,  every  child  possesses  more  or  less  an  imitative 
power,  and  will  acquire  from  its  mother  habits  of  speech  and  conduct 
very  much  sooner  than  is  usually  supposed.  Outbursts  of  petulant 
anger,  the  use  of  improper  language,  or  unseemly  levity  of  conduct, 
will  often  produce  on  the  young  mind  impressions  which  may  react  to 
its  disadvantage  and  injury  in  later  years  ;  while,  on  the  other  hand, 
dignified  control  of  temper  and  gentle  manners  will  be  imitated  in  early 
childhood,  and  impress  permanently  the  character  in  after  life. 

Many  considerations  of  a  similar  nature  might  be  adduced  to  illus¬ 
trate  the  influence  which  maternal  characteristics  may  have  upon  chil¬ 
dren  ;  but  enough  has  been  said  to  impress  upon  all  expectant  mothers 
the  propriety  and  desirability  of  conscientiously  regulating  their  con¬ 
duct  during  pregnancy  and  in  motherhood,  so  that  right  impulses  and 
healthy  energies  should  spread  outward  in  an  increasing  wave  through 
successive  generations. 

It  is  related  in  the  life  of  the  Rev.  Charles  Kingsley,  that  when  his 
mother  became  aware  that  she  was  about  to  bear  a  child,  she  firmly 
resolved  that  during  her  pregnancy  she  wuuld  allow  no  external 
troubles  to  influence  her  mind,  and  that,  living  in  a  beautiful  country, 
she  would  give  up  as  much  time  as  possible  to  the  contemplation  of 
natural  beauty  and  to  admiration  of  the  works  of  the  Almighty  ;  and 
it  is  easy  to  believe  that  the  thorough  sympathy  with  Nature,  and  the 
earnest  humanity  which  characterized  the  author  of  “The  Water 
Babies  ”  and  “Yeast,”  were  due  in  great  measure  to  the  mental  attitude 
of  his  mother  during  the  months  preceding  his  birth.  Every  mother 
cannot  carry  out  these  principles  to  the  same  extent  ;  but  it  is  possible 
for  every  expectant  mother  to  look,  as  far  as  may  be,  rather  to  the 
future  happiness  of  motherhood  than  to  the  present  discomforts  of 
pregnancy  ;  to  feel  that  in  becoming  a  mother  she  is  fulfilling  a  duty 
high  and  important ;  and  to  the  best  of  her  ability  to  contemplate  the 
brighter  side  of  the  picture,  encouraged  by  the  constantly  nearing 
approach  of  maternal  joy. 


THE  HONEYMOON. 


1 


\ 


CHAPTER  II. 

Altered  Conditions  or  Life  after  Marriage. 

Change  In  the  Circumstances  of  the  Wife;  Loss  of  Family  Ties;  Formation  of 
New  Friendships;  Utilization  of  Leisure  Hours;  Importance  of  Out-door 
Exercise;  Various  Forms  of  Exercise;  Value  of  Motive  in  Walking;  Care 
in  Diet;  Duty  of  Taking  Proper  Care  of  Health;  Place  of  Alcoholic  Stimu¬ 
lants  in  Diet;  Injurious  Effects  of  Improper  Use  of  Stimulants  on  Mother 
and  Child;  Mental  Occupation;  Tendency  to  Occasional  Depression; 
Methods  of  Eelief;  Domestic  Troubles;  Eule  for  Avoiding  Worry. 

Marriage  is  followed  by  a  very  mucli  greater  change  in  the  circum¬ 
stances  and  habits  of  the  wife  than  in  those  of  the  husband.  The  latter 
still  pursues  the  daily  occupation  to  which  he  has  been  accustomed  for 
years,  one-third  at  least  of  his  time  probably  being  devoted  to  the 
claims  of  his  profession  or  business ;  and,  in  general,  he  is  still  sur¬ 
rounded  by  his  old  friends,  and  to  some  extent  is  able  to  participate  in 
his  usual  recreations.  On  the  other  hand,  the  wife  will  most  commonly 
find  herself  in  a  completely  novel  position.  Her  family  ties  are  more 
completely  broken,  and  the  occupations  of  girlhood  are  exchanged  for 
the  more  responsible  duties  of  housekeeping  ;  while  she  will  often  find 
herself  separated  by  distance  from  old  friends,  and  under  the  necessity 
of  creating  a  new  circle  of  friends  and  acquaintances  in  her  more 
immediate  neighborhood.  It  is  impossible  that  such  a  change  can  be 
suddenly  effected  without  more  or  less  discomfort  and  annoyance. 

To  many  women,  even  when  young,  the  making  of  new  friendships 
is  a  difficult  and  slow  process  ;  and  the  difficulty  is  one  which  generally 
increases  with  progressing  years.  Yet,  to  most  young  married  women, 
the  companionship  of  at  least  a  few  friends  is  very  desirable,  if  not  abso¬ 
lutely  necessary,  for  the  maintenance  of  health.  The  general  condi¬ 
tions  of  social  life  generally  render  it  a  necessary  misfortune,  for  all 
but  the  very  wealthy,  that  the  husband  should  be  absent  from  home  lor 
many  hours  daily  in  the  pursuit  of  his  business  ;  and  even  with  the 
occupation  and  excitement  to  which  early  adventures  in  housekeeping 
may  give  rise,  there  must  often  be  many  lonely  and  occasionally  weary 
hours  for  the  wives  who  are  left  at  home.  It  is  a  duty  which  a  wife 
owes  to  her  husband  as  well  as  to  her  health  to  make  every  effort  to 
use  well  these  solitary  hours. 


16 


i6 


EARLY  MARRIED  LIFE. 


A  very  common  failing,  especially  among  those  whose  life  is  spent 
in  large  towns,  is  the  tendency  to  lead  too  sedentary  a  life,  and  to 
neglect  the  regular  outdoor  exercise  which  is  indispensable  to  good 
health.  No  fact  in  physiology  is  more  clearly  proved  than  the  necessity 
of  physical  exercise  of  some  kind,  if  health  is  to  be  maintained  in  a 
satisfactory  condition.  The  form  that  the  exercise  may  take  is  of  minor 
importance.  To  those  who  can  afford  it,  riding  on  horseback  is  a  very 
agreeable  and  most  valuable  form;  and  bicycle  riding  is  within  the 
reach  of  many  who  cannot  afford  the  luxury  of  a  living  steed.  There 
is  no  reason  to  suppose  that  any  injury  can  result  to  a  healthy  woman 
by  tricycling  in  moderation  ;  and  one  of  its  advantages  is  that  the 
pleasure  can  often  be  shared  by  one’s  husband,  as  tandem  tricycling  is 
even  more  easy  than  single  riding,  if  the  two  riders  are  accustomed  to 
each  other’s  action.  To  those  who  live  in  the  neighborhood  of  rivers, 
or  at  the  seaside,  rowing,  and  more  especially  sculling,  is  an  equally 
delightful  and  useful  mode  of  exercise,  and  one  very  well  suited  to 
young  women  who  are  sensible  enough  to  wear  a  dress  suitable  for  the 
purpose. 

The  majority  of  young  married  women  will,  however,  probably 
have  to  content  themselves  with  -walking  exercise.  It  is  frequently 
asked  how  much  walking  exercise  should  be  undertaken  daily  ;  and  the 
question  is  one  to  which  it  is  impossible  to  give  a  definite  answer. 
Much  depends  upon  the  temperament,  the  strength,  and  the  nervous 
energy  of  the  inquirer,  as  well  as  upon  the  circumstances  under  which 
the  exercise  is  taken.  It  is  a  matter  of  daily  observation  that  one  can 
walk  much  farther  with  less  fatigue  if  one  has  an  interesting  compan¬ 
ion,  or  a  special  object  in  view.  It  may  be  said  generally  that  most 
women  would  be  the  better  for  walking  at  least  three  or  four  miles 
daily,  while  many  are  quite  able  to  enjoy  thoroughly  and  benefit  by  a 
wralk  of  six  or  eight  miles.  If  no  special  motive  for  walking  exists,  it 
is  often  well  to  invent  one.  Dealing  with  shops  at  some  distance  from 
one’s  home  sometimes  offers  an  inducement  for  exercise  ;  or  visiting 
friends  at  some  distance  from  one’s  residence  may  be  a  convenient 
motive.  The  main  point  is  to  avoid  what  is  sometimes  called  “taking 
a  constitutional,”  a  proceeding  which  is  very  unlikely  to  have  the 
desired  effect  in  promoting  health. 

In  addition  to  regularity  of  exercise,  regularity  of  diet  is  of  prime 
importance  to  the  maintenance  of  good  health  in  early  married  life.  It 
is,  however,  a  duty  which  is  rather  apt  to  be  neglected.  Women  are 
sometimes  inclined  to  think  that  there  is  a  certain  amount  of  selfishness 
in  considering  their  own  wants  in  the  absence  of  their  husbands  ;  and 
instead  of  taking  regular  and  proper  meals,  to  temporize  with  some 
substitute,  such  as  tea,  Which,  while  it  stimulates  and  removes  tempor¬ 
arily  the  sense  of  fatigue  and  hunger,  really  affords  nothing  that  can 


EARLY  MARRIED  LIFE. 


17 

properly  be  termed  food.  There  is  no  real  selfishness  in  supplying 
one's  wants  in  such  a  way  as  to  maintain  one’s  self  in  good  health  ;  and 
it  is  a  duty  women  owe  to  their  husbands  to  regulate  their  lives  so  as  to 
be  fit  companions  for  them,  and  healthy  mothers  for  their  children. 
To  women  who  breakfast  early,  and  whose  evening  meal  is  late,  it  is 
most  essential  to  have  a  proper  substantial  meal  in  the  middle  of  the 
day,  of  which  a  part  should  consist  of  some  kind  of  meat  or  fish. 

Effect  of  Stimulants. — Young  women  should  especially  be  care¬ 
ful  to  avoid  acquiring  the  habit  of  taking  any  alcoholic  fluids  to  supply 
the  place  of  more  valuable  food.  The  proper  place  of  alcoholic  stimu¬ 
lants,  so  far  as  they  may  be  required  or  taken  at  all,  is  as  an  adjuvant 
to  the  more  solid  meals  of  the  day  ;  and,  even  then,  they  should  only 
be  taken  in  very  moderate  quantity.  Probably  the  majority  of  women 
will  enjoy  better  health  while  abstaining  from  all  alcoholic  drinks  ;  but 
even  in  cases  where  the  digestion  is  assisted  and  health  improved  by 
a  little  wine  or  beer  taken  with  meals,  an  invariable  rule  should  be 
adopted  that  no  stimulants  be  taken  at  any  other  time  without  direct 
medical  sanction  or  recommendation.  Irregular  stimulant-drinking  is 
not  only  directly  injurious  in  many  ways,  but  also  the  indirect  cause  of 
many  maladies,  more  especially  of  the  nervous  system,  and  is  exceed¬ 
ingly  apt  to  lead  to  permanent  habits  of  inebriety.  Considerable  expe¬ 
rience  has  shown  that  this  practice  is  one  of  the  most  fertile  causes  of 
unhappy  married  life  ;  while  conclusive  evidence  proves  its  injurious 
effect  upon  the  health  of  the  offspring. 

Health  of  the  Mind. — While  due  attention  is  given  to  the  mate¬ 
rial  requirements  of  the  body,  another  equally  important  condition  of 
health  is  the  maintenance  of  the  mind  in  properly  regulated  employment. 
Real  health  is  only  obtainable  when  both  the  mind  and  the  body  are 
kept  in  satisfactory  condition  by  active  exercise.  It  is  no  uncommon 
thing  for  young  women  after  marriage  to  give  up  the  occupations  of 
the  leisure  which  they  enjoyed  before  other  interests  occupied  their 
attention  ;  and  when  the  novelty  of  the  altered  life  has  somewhat  faded, 
it  is  not  unfrequent  to  observe  mental  depression,  and  occasional  ten¬ 
dency  to  hysteria,  as  the  result  of  a  sense  of  loneliness  and  absence  of 
interesting  intellectual  resource.  Commencing  in  this  way,  the  depres¬ 
sion  may  and  often  does  lead  eventually  to  indigestion,  and  sleeplessness, 
and  manifests  itself  externally  in  irritability  and  unhappiness.  It  is 
very  desirable  that  young  married  women  should  have  at  least  one 
mental  resource  upon  which  they  can  fall  back  when  irritated  by  the 
t  roubles  of  housekeeping,  or  when  suffering  from  the  ennui  resulting 
from  separation  from  old  friends.  Whether  that  resource  be  music, 
reading,  singing,  drawing,  or  any  other  so-called  accomplishment,  it 
should  be  cultivated  with  assiduity  and  regularity  ;  for  of  all  these  it 
may  be  said  that  the  pleasure  derived  from  them  increases  with  prac- 


EARLY  MARRIED  LIFE. 


18 

^ice  and  use,  and  decreases  with  neglect.  Both  in  earlier  and  later  life, 
wc  shall  reap  the  reward  of  some  self-sacrifice  in  the  practice  of  pur¬ 
suits  which  both  afford  pleasure  and  extend  and  cultivate  our  mental 
resources. 

Minor  Troubles  of  Life. — Every  young  woman  who  commences 

housekeeping  on  even  a  very  moderate  scale  must  expect  to  encounter 
a  certain  number  of  troubles  and  worries.  She  has,  in  many  cases,  to 
enter  into  relations  with  others  in  a  sphere  rather  different  from  her 
own,  and  it  is  impossible  that  without  experience  she  can  realize  and 
understand  their  point  of  view,  just  as  it  is  very  unlikely  that  they  will 
understand  or  appreciate  hers.  It  is  most  necessary  for  her  peace  of 
mind  that  she  should  perceive  that  there  are  usually  at  least  two  points 
of  view  from  which  things  can  be  regarded  ;  and  that  her  own  is  not 
necessarily  the  right,  still  less  the  only  one.  And  while,  naturally,  we 
all  prefer  our  own  view,  it  is  very  foolish  to  be  annoyed  because  other 
people  prefer  theirs.  A  golden  rule  which  will  often  save  us  from 
petty  worries  is — to  strive  resolutely  to  allow  only  our  own  conduct  to 
affect  our  mental  condition  ;  to  rest  satisfied  wTith  doing  our  very  best ; 
and  having  done  this,  to  disregard,  as  far  as  possible,  the  failure  of 
others  to  attain  our  own  particular  standard.  It  has  been  remarked 
that  there  are  two  classes  of  circumstances  in  life  which  should  never 
be  allowed  to  annoy  us :  those  circumstances  that  can  be  helped,  and 
those  that  cannot ;  the  former,  being  under  our  own  control,  may  be 
obviated,  and  the  latter,  being  beyond  our  control,  should  be  disre¬ 
garded.  Oliver  Wendell  Holmes,  in  one  of  his  works,  remarks  that  the 
human  race  might  be  divided  into  the  “Ifs”  and  the  “Ases,”  the 
'* If 8  ”  being  those  who  desire  unattainable  conditions  for  their  hap¬ 
piness,  and  the  “Ases”  those  who  accept  facts  as  they  are  and  make 
the  best  of  them.  Every  young  woman  who  wishes  to  make  the  best 
of  her  life  should  resolve  to  place  herself  at  once  in  the  latter  class. 


CHAPTER  III 


Signs  and  Symptoms  op  Pregnancy. 


Their  Existence  and  Import;  Plan  of  Consideration;  Cessation  of  Menstrua¬ 
tion;  Its  Significance  and  Value  in  Determining  Probable  Duration  of  Preg¬ 
nancy;  Normal  Duration  of  Pregnancy;  Extreme  Limits  of  Duration; 
Methods  of  Determining  Probable  Date  of  Confinement;  Examples.  Gas¬ 
tric  Derangements;  Morning  Sickness;  Abnormal  Sense  of  Hunger;  Crav¬ 
ing  for  Unusual  Articles  of  Diet;  Pain  in  Stomach;  Other  Disorders  of  Di¬ 
gestion.  Enlargement  of  Breasts;  Tenderness;  Prominence  of  Veins; 
Secretion  of  Milk;  Enlargement  and  Pigmentation  of  Areola;  Secondary 
Areola;  Quickening  and  Sensations  of  Movement  of  Child;  Possibility  of 
Mistake  in  Sensations;  External  Evidence  of  Movement;  Increase  in  Size 
of  Abdomen;  Period  at  which  Noticeable;  Conclusion. 

The  commencement  and  progress  of  pregnancy  are  usually  char¬ 
acterized  by  certain  external  and  objective  signs ,  and  certain  internal 
and  subjective  symptoms ,  which  in  general  are  sufficiently  pronounced 
to  inform  the  expectant  mother  with  fair  certainty  both  of  the  condi¬ 
tion  she  is  in,  and  of  the  probable  period  of  its  eventuation.  Of  these 
signs  and  symptoms  some  are  only  occasionally  present,  but  when 
present  are  of  much  value  ;  others  are  always  present,  although  their 
meaning  may  occasionally  be  misinterpreted  ;  while  others  again,  though 
frequently  present,  are  not  of  material  importance  in  determining  the 
existence  of  pregnancy,  as  they  often  accompany  other  conditions  not 
related  to  pregnancy.  Some  of  the  signs  also  can  only  be  appreciated 
by  a  duly  qualified  medical  man  ;  no  mention  will  be  made  of  such 
mdications  in  the  descriptions  which  follow.  In  regard  to  those  which 
are  described,  their  value  as  symptoms,  and  the  frequency  with  which 
they  occur,  will  as  far  as  possible  be  pointed  out,  together  with  the 
bearing  of  each  on  the  question  as  to  the  period  of  gestation  which  may 
have  been  reached,  and  the  consequent  determination  of  the  date  at 
which  confinement  may  be  anticipated.  The  consideration  of  the 
duration  of  ordinary  pregnancy  will  be  better  entered  upon  after  the 
first  symptom  has  been  described  and  explained. 

Cessation  of  Menstruation. — As  a  general  rule,  the  existence  of 
pregnancy  is  first  suggested  by  the  cessation  of  the  usual  monthly 
period.  While  in  different  women  the  period  of  time  between  the 
so-called  “monthly”  periods  may  vary  from  less  than  three  to  more 


20 


SIGNS  OF  PREGNANCY. 


than  five  weeks,  in  the  same  individual  the  intervals  are  usually  fairly 
uniform  ;  and  although  it  is  not  very  uncommon  in  early  married  life 
to  notice  a  slight  deviation  from  this  regularity,  a  postponement  of  the 
monthly  period  for  more  than  two  weeks  beyond  the  ordinary  interval 
always  suggests  at  least  the  possibility  of  pregnancy,  while  if  entire 
cessation  results,  in  the  absence  of  any  other  apparent  cause,  the  prob¬ 
ability  of  pregnancy  is  exceedingly  strong.  In  not  a  few  cases,  what 
is  at  first  observed  is  not  absolute  cessation  of  the  period,  but  a  dimin¬ 
ished  menstrual  flow  for  a  shorter  time  than  usual ;  and  only  on  the 
following  occasion  when  the  period  is  expected  is  the  menstrual  flow 
entirely  arrested. 

The  value  of  this  sign  is  considerable.  Arrest  of  the  menstrual 
flow,  in  the  absence  of  illness,  and  when  no  chill  followed  by  pain  has 
been  experienced'  is  very  exceptional  in  healthy  young  women  ;  so 
that  when  the  arrest  occurs,  unaccompanied  by  any  symptoms  of  dis¬ 
ordered  health,  there  is  a  strong  presumption  that  it  is  to  be  referred  to 
the  existence  of  pregnancy.  Its  significance  when  present  is  not  dimin¬ 
ished  by  the  fact  that  a  comparatively  small  number  of  young  women 
continue  to  have  their  menstrual  period  during  the  first  three  or  four 
months  of  pregnancy — in  some  cases  certainly  rather  diminished  in 
amount ;  while  a  very  few  have  a  periodic  colored  discharge  through 
the  whole  duration  of  gestation.  Such  instances,  however,  are  relatively 
very  uncommon.  The  fact  that  menstruation  usually  ceases  from  the 
commencement  of  pregnancy,  is  of  great  value  in  enabling  one  to  deter¬ 
mine  the  time  at  which  confinement  is  likely  to  take  place.  « 

Duration  of  Pregnancy. — The  ordinary  duration  of  pregnancy 
is  usually  presumed  to  be  from  273  to  280  days,  that  is,  about  nine  cal¬ 
endar  months,  or  ten  lunar  months  of  28  days  each.  There  is  some 
evidence  to  show  that  confinement  frequently  takes  place  about  what 
would  be  the  tenth  menstrual  period  after  the  last  period  before  the 
cessation  of  the  menstrual  flow,  so  that  women  who  menstruate  rather 
more  frequently  than  every  28  days  would  probably  have  a  shorter 
period  of  gestation  than  those  who  have  longer  intervals  between  the 
monthly  periods.  Gestation,  however,  for  a  much  shorter  time  than 
nine  calendar  months  is  exceptional ;  and  if  the  duration  is  more  than 
two  wreeks  short  of  that  period,  the  baby  will  generally  show  some 
indications  of  premature  birth.  On  the  other  hand,  the  duration  of 
pregnancy  beyond  280  days  is  not  at  all  uncommon  ;  not  very  unfre- 
quently  gestation  is  prolonged  beyond  300  days,  and  even  in  some  cases 
as  long  as  45  or  46  weeks.  Such  instances  are,  however,  undoubtedly 
rare ;  and  in  the  large  majority  of  cases,  pregnancy  is  terminated  by 
mature  confinement  at  the  end  of  about  40  weeks. 

For  the  purpose  of  determining  as  accurately  as  possible  Ike  proba¬ 
ble  date,  of  .confinement,  it  is  usual  to  assume  that  the  commencement 


DURATION  OF  PREGNANCY. 


21 


of  pregnancy  dates  from  about  one  week  after  the  last  observed  men¬ 
strual  period,  the  beginning  of  pregnancy  being  most  likely  to  occur  at 
that  time  ;  and  to  estimate  that  confinement  will  take  place  not  earlier 
than  nine  calendar  months  from  that  date.  Thus,  if  the  last  menstrual 
period  ceased  on  the  1st  of  January,  one  would  allow  one  week  from 
that  day,  and  calculate  that  confinement  would  occur  not  earlier  than 
the  8th  of  September.  It  is  generally  believed  also  that,  next  to  one 
week  after  the  menstrual  period,  pregnancy  most  commonly  commences 
immediately  before  the  menstrual  period  ;  and  allowing  nine  months 
from  that  date,  the  calculation  would  be  made  that  confinement  would 
not  be  later  than  nine  calendar  months  and  three  weeks  from  the  cessa¬ 
tion  of  the  last  observed  menstrual  period.  Utilizing  the  example 
given  above,  and  assuming  that  an  individual  menstruated  every  28 
days,  if  the  last  menstruation  terminated  on  January  1st,  the  next 
would  have  been  expected  on  January  29th  ;  and  on  the  assumption  that 
pregnancy  may  have  commenced  two  day's  before  that  date,  it  would 
be  concluded  that  the  pregnancy  might  not  be  determined  by  confine¬ 
ment  before  the  27th  of  September.  Since,  however,  the  pregnancy 
may  begin  at  any  time  between  the  menstrual  periods,  the  date  of  con¬ 
finement  would  lie  approximately  between  the  8tli  and  27th  of  Septem¬ 
ber,  with  the  possibility  of  occurring  even  one  week  earlier  ;  and  in 
most  cases  this  approximation  of  dates  is  the  greatest  degree  of  cer¬ 
tainty  which  can  be  reached,  at  least  when  it  is  a  first  pregnancy  that 
is  in  question.  In  later  pregnancies,  a  greater  degree  of  certainty 
can  frequently  be  attained,  from  the  fact  that  successive  pregnancies 
are  apt  to  follow  the  same  course  as  to  duration  and  period  of  com¬ 
mencement.  In  regard  to  the  probability  of  the  later  or  earlier  date 
beino;  the  true  one,  there  seems  some  evidence  to  show  that  where  there 
has  been  a  slight  and  exceptionally  small  menstrual  period  last  ob¬ 
served,  the  pregnancy  may  date  from  immediately  before  it ;  whereas, 
when  the  last  observed  period  has  been  one  of  usual  character,  the 
probability  will  be  that  pregnancy  commenced  within  a  week  after  it. 
In  other  words,  when  pregnancy  commences  immediately  before  a 
menstrual  period,  the  period  is  not  always  entirely  prevented,  but  is 
diminished  in  duration  and  amount.  This,  however,  is  not  by  any 
means  invariable  ;  and  it  is  generally  safer,  in  making  arrangements  for 
a  confinement,  to  assume  that  it  may  occur  on  any  day  after  the  date 
calculated  from  the  "week  succeeding  the  last  ordinary  menstrual  period. 

In  the  exceptional  instances  where  menstruation  is  not  arrested 
during  pregnancy,  the  difficulty  of  estimating  the  probable  date  of  con¬ 
finement  is  considerably  increased,  and  an  equal  degree  of  accuracy  is 
not  usually  obtainable  ;  although  considerable  assistance  in  the  calcu¬ 
lation  is  not  unfrequently  derived  from  the  symptoms  we  are  next  to 
consider,  as  well  as  from  others  to  be  described  farther  on. 


22 


SIGNS  OF  PREGNANCY 


Gastric  Derangements  of  Pregnancy. — Very  few  women  go 
through  the  whole  course  of  a  first  pregnancy  without  some  disturb¬ 
ances  of  health  referable  to  the  stomach  and  other  organs  of  digestion  ; 
and  in  later  pregnancies  also  affections  of  this  character  are  of  very 
frequent  occurrence.  The  more  usual  gastric  derangements  are,  morn¬ 
ing  sickness,  abnormal  hunger,  cravings  for  unwonted  articles  of  diet, 
and  pain  in  the  stomach. 

1.  Horning  Sickness. — The  most  common  form  observed  is  that 
of  a  feeling  of  sickness  on  rising  from  bed  in  the  morning,  resulting  in 
a  few  minutes  in  some  amount  of  retching.  With  some  the  sensation 
only  lasts  for  two  or  three  minutes  in  all,  and  may  pass  off  without 
any  retching  or  vomiting  ;  with  others  the  sense  of  sickness  may  be 
not  only  severe,  but  accompanied  by  retching  and  vomiting  of  watery 
mucus  for  a  period  extending  from  fifteen  minutes  to  half  an  hour. 
Generally  speaking,  this  symptom,  if  it  occurs  at  all,  occurs  at  a  very 
early  stage  of  pregnancy,  not  unfrequently  showing  itself  even  in  the 
first  week,  so  that  it  may  precede  in  date  of  appearance  the  cessation  of 
menstruation  described  in  the  previous  section.  When  it  has  once 
commenced,  it  is  apt  to  recur  every  day  under  similar  circumstances 
for  some  little  time,  often  lasting  during  the  whole  of  the  first  three 
months  of  pregnancy  ;  in  rome  cases  it  continues,  with  perhaps  occa¬ 
sional  remissions,  during  the  whole  pregnancy,  but  these  are  exceptional. 
The  intensity  and  duration  of  the  retching  will  usually  vary  from  day 
to  day,  and  a  day  or  two  may  elapse  when  no  sickness  is  present ;  but 
even  then  a  slight  sense  of  nausea  is  usually  experienced  for  a  little 
time. 

As  an  early  symptom  of  pregnancy,  this  indication  is  very  valuable, 
for  the  character  of  the  retching  is  different  from  anything  that  occurs 
in  ordinary  health.  Sickness  of  a  similar  kind  is  common  in  some 
severe  affections  of  the  stomach,  and  in  persons  prone  to  alcoholic 
excess  ;  but  the  peculiar  combination  of  morning  sickness  without  any 
other  apparent  affection  of  the  stomach,  and  with  good  health  enjoyed 
during  the  rest  of  the  day,  is  strongly  indicative  of  pregnancy.  As  an 
indication  of  the  probable  period  of  confinement,  the  fact  of  its  usual 
commencement  within  six  weeks  of  the  beginning  of  pregnancy  affords 
approximate  evidence  ;  while  in  the  instances  in  which  it  is  experienced 
before  the  cessation  of  the  menstrual  period,  the  dates  of  the  com¬ 
mencement  of  pregnancy  and  the  probable  time  of  confinement  can 
usually  be  fixed  within  one  or  two  weeks.  In  some  cases,  where  morn¬ 
ing  sickness  has  commenced  within  one  week  after  a  normal  menstrual 
period,  the  beginning  of  the  pregnancy  can  be  certainly  estimated 
within  two  or  three  days’  range. 

2.  Abnormal  Sense  of  Hunger  and  Craving  for  Food  is 

another  form  of  disorder  of  digestion  somewhat  characteristic  of  preg- 


CRAVINGS  IN  PREGNANCY. 


23 


nancy.  This  sensation,  which  may  he  present  contemporaneously  with 
morning  sickness,  or  may  exist  in  the  absence  of  the  latter  symptom,  is 
generally  observed  in  the  form  of  sudden  accesses  of  hunger  at  irreg¬ 
ular  periods  throughout  the  day,  and  occasionally  also  during  the 
night,  temporarily  relieved  by  partaking  of  a  small  quantity  of  food. 
The  hunger  is  exceptional  in  its  characteristics — viz.,  frequent  recur¬ 
rence,  and  relief  by  a  smaller  quantity  of  food  than  would  ordinarily 
satisfy  a  hungry  person.  In  not  a  few  cases,  indeed,  the  sensation  of 
hunger  is  succeeded  on  commencing  to  eat  by  an  early  sense  of  reple¬ 
tion,  and  sometimes  even  by  actual  nausea.  Sometimes  the  sensation 
is  described  as  a  feeling  of  faintness  rather  than  hunger ;  in  that  form 
also  it  is  generally  temporarily  relieved  by  taking  food. 

3.  Cravings  for  Unwonted  Articles  of  Food.— A  third  form 
of  disordered  digestion  is  seen  in  cravings  for  unusual  and  often  un¬ 
wholesome  articles  of  diet.  Women  who  have  been  accustomed  to 
plain  and  regular  diet  occasionally  have  longings  for  articles  of  food 
which  they  have  not  been  in  the  habit  of  indulging  in,  and  which  they 
have  even  formerly  disliked.  More  especially  is  observed  a  frequent 
craving  for  rather  highly  flavored  articles  of  diet,  such  as  rich  ripe 
cheese,  pickles,  smoked  fish,  etc. 

4.  Pain  in  the  Stomach  is  an  unfrequent  symptom,  and,  when 
it  is  observed  in  the  absence  of  sickness,  usually  takes  the  form  of  acute 
pain  immediately  following  the  taking  of  food.  It  is  sometimes  of  a 
very  acute  character,  resembling  neuralgia,  and  can  be  relieved  by  the 
artificial  induction  of  vomiting. 

The  second  and  third  forms  of  gastric  disturbance  just  described  are 
of  considerable  value  in  determining  the  existence  of  pregnancy,  as  they 
do  not  usually  characterize  or  accompany  ordinary  types  of  indigestion, 
or  more  serious  maladies  of  the  stomach.  With  regard  to  the  period  of 
pregnancy  attained,  they  do  not  give  any  very  valuable  information,  as 
they  are  not  uncommonly  found  at  any  time  during  the  whole  nine 
months  of  pregnancy  ;  but,  considered  in  connection  with  other  signs 
and  symptoms  present,  they  occasionally  give  some  assistance  in  deter¬ 
mining  the  probable  date  of  confinement.  The  fourth  form  mentioned 
(pain  in  the  stomach)  is  not  reliable  as  a  symptom,  since  it  not  unlre- 
quently  accompanies  different  diseases  of  the  stomach,  and  has  no 
exceptional  character  when  present  in  cases  of  pregnancy.  Other  dis¬ 
orders  of  digestion,  such  as  discomfort,  sense  of  fulness,  heartburn, 
and  vomiting  at  other  times  than  on  rising  in  the  morning,  are  not  of 
sufficient  significance  to  be  dealt  with  as  symptoms  of  pregnancy,  and 
will  be  mentioned  more  suitably  in  a  future  chapter  (on  the  discomforts 
of  pregnancy  and  their  treatment).  In  closing  this  section,  however,  it 
may  be  added  that  marked  sensations  of  sickness,  and,  still  more; 
attacks  of  retching  and  vomiting  occurring  irregularly  at  any  period  of 


24 


SIGNS  OF  PREGNANCY. 


the  day,.-  and  without  any  relation  to  the  hours  of  taking-  food,  always- 
suggest  the  possibility  of  pregnancy,  in  the  absence- of  any  illness 
which  might  otherwise-  account  for  them.--  ......... 

Enlargement  of  Breasts. — In  most  young  women,  either  a  few 
days  before,  or  else  during  the  menstrual  period,  the  breasts  become 
somewhat  fuller  and  larger ;  and  this  temporary  increase  of  size  is 
often  attended  with  some  degree  of  tenderness.  It  is  generally  found 
that,  shortly  after  the  commencement  of  pregnancy,  this  enlargement 
and  fulness  not  only  remain  permanently,  but  even  tend  gradually  to 
increase  ;  while  any  tenderness  which  may  have  formerly  been  asso¬ 
ciated  with  the  fulness  usually  disappears.  The  fulness  is  further 
accompanied  and  characterized  by  a  feeling  of  greater  firmness,  and  a 
sense  of  increased  resistance  on  gentle  pressure.  Often  also  there  is  an 
apparent  increase  in  size  of  the  blue  veins  which  are  seen  under  the 
skin  covering  the  breast,  and  veins  which  were  not  apparent  before 
become  markedly  prominent  on  the  surface,  both  of  the  breasts  them¬ 
selves,  and  of  the  bust  in  the  vicinity  of  the  breasts.  The  nipples  also 
sometimes  become  rather  larger  and  more  prominent,  and  occasionally 
in  some  cases  discharge  a  little  watery  fluid  or  even  milk.  The  symp¬ 
tom  is  sometimes  accompanied  by  shooting  pains,  and  sometimes  by 
throbbing  in  the  breasts  ;  but  much  pain  or  discomfort  of  this  kind  is 
rare.  As  a  sign  of  pregnancy  it  occurs  early,  the  enlargement  being 
often  noticeable  from  the  first  month,  and  its  presence  will  strengthen 
considerably  the  evidence  afforded  by  any  other  symptoms  which  may 
be  present.  The  time  at  which  it  occurs,  however,  is  not  sufficiently 
uniform  for  it  to  be  of  value  as  an  indication  of  the  date  of  the  preg¬ 
nancy.  A  sign  closely  allied  to  this  now  to  be  described  affords  more 
valuable  information. 

Enlargement  and  Pigmentation  of  Areola  of  Breasts.— The 

color  of  the  skin  in  a  circular  area  of  varying  size  round  the  nipples 
differs  from  that  of  the  rest  of  the  breast.  This  exceptionally  colored 
circle,  which  varies  in  diameter  in  different  women — in  some  measuring- 
only  about  one  inch  from  side  to  side,  in  others  about  two  inches — is 
known  as  the  areola  of  the  breast.  In  fair  women  the  color  is  usually 
a  very  light  pink,  while  in  those  of  darker  complexion  it  may  vary 
from  a  bright  red  to  a  pale  brown  color,  being  usually  darkest  in 
women  with  black  hair.  Occasionally,  small  projecting  prominences 
about  the  size  of  the  head  of  a  pin  are  observable  here  and  there  within 
the  areola  ;  these  are  the  orifices  of  glands  of  the  skin. 

In  the  course  of  pregnancy  this  areola  very  generally  becomes  both 
larger  in  circumference  and  deeper  in  color.  Both  these  results  are 
more  conspicuous  in  women  of  dark  complexion,  the  color  of  the 
areola  being  already  more  defined  before  the  commencement  of  preg¬ 
nancy  ;  but  the  increase  in  size  is  often  very  noticeable  even  in  women 


CHANGES  IN  THE  BREASTS. 


25 


of  markedly  fair  complexion.  The  alteration  is  accompanied  frequently 
by  some  enlargement  and  increased  prominence  of  the  glands  of  the 
skin  referred  to  above.  The  enlargement  of  the  areola  and  the  deep¬ 
ened  color  can  often  be  distinguished  by  the  end  of  the  second 
month  of  pregnancy  ;  and  after  three  months  have  elapsed  from  the 
commencement,  they  are,  except  in  a  few  fair  women,  very  distinct. 
As  a  sign  of  existing  pregnancy,  the  areola  is  only  of  moderate  impor¬ 
tance,  as  similar  conditions  are  observed  occasionally  in  connection 
with  some  forms  of  disease  ;  but  when  it  occurs  in  good  health,  and  in 
combination  with  other  signs  described,  its  presence  materially  strength- 


Fig.  1. 


SHOWING  CHANGE  IN  THE  AREOLA  AND  NIPPLE  DURING  PREGNANCY. 

ens  the  certainty.  Conclusions  of  fair  accuracy  also  may  be  arrived  at 
from  this  sign  of  the  stage  of  pregnancy  reached,  if  it  is  considered 
along  with  the  sign  about  to  be  described.  [A  plate  of  color  illustra¬ 
tions  comparing  the  virgin  breasts  with  those  of  early  pregnancy  may 
be  seen  in  Chapter  II.  of  “Plain  Home  Talk.”] 

Secondary  Areola  of  the  Breast.— Between  four  and  five 
months  after  pregnancy  commences,  in  most  women  who  are  not  excep¬ 
tionally  fair  in  complexion,  a  slightly  discolored  ring  develops  just 
outside  the  areola.  It  is  of  paler  color  than  the  areola,  shading  it  off, 
as  it  were,  into  the  normally  colored  skin  of  the  breast ;  and  varies  in 
breadth  from  half  an  inch  to  an  inch  and  a  half  or  more.  Its  most 
characteristic  peculiarity  is,  that  the  coloration  is  not  uniform  as  in 
the  areola,  but  mottled — just  as  if  drops  of  water  had  fallen  heie  and 


26 


SIGNS  OF  PREGNANCY. 


there  on  the  surface,  and  partially  washed  off  the  color.  The  appear¬ 
ance  is  somewhat  striking,  and  is  peculiar  to  pregnancy  ;  so  that,  when 
well  marked,  it  may  be  accepted  as  a  certain  indication ;  and  the 
period  of  pregnancy  at  which  it  appears  is  fairly  uniform.  All  the 
three  signs  described  above  relating  to  the  breasts  remain  after  devel¬ 
opment  until  the  termination  by  delivery,  and  the  increased  color 
frequently  remains  long  afterwards.  Often,  indeed,  the  color  of 
the  areola  never  in  after  life  regains  its  original  paleness  and 
softness. 

Quickening  and  other  Sensations  of  Movement  of  the  Child. 

— By  the  term  “quickening”  is  meant  the  first  perception  by  the 
mother  of  the  movement  of  the  infant  in  her  womb.  From  a  very 
early  period  of  its  existence  in  the  womb,  the  child  possesses  some 
power  of  movement ;  but  during  the  first  one  or  two  months  of  preg¬ 
nancy  the  movements  are  so  feeble  and  slight  as  to  be  imperceptible  to 
the  mother.  The  movements  apparently  consist  at  first  chiefly  of 
motions  of  the  legs  in  straightening  and  bending  them ;  and  are  per¬ 
formed  so  quickly  as  to  have  the  character  of  kicking.  As  the  growth 
of  the  child  progresses,  there  are  movements  of  the  arms  also,  and 
rolling  or  tumbling  about  of  the  whole  body  within  the  fluid  in  which 
it  is  immersed  in  the  interior  of  the  womb.  With  many  women  the 
first  experience  of  this  movement  has  a  very  marked  character,  some¬ 
times  exciting  sudden  faintness,  sometimes  a  tendency  to  hysteria, 
sometimes  a  sensation  of  indescribable  nature,  almost  amounting  to  pain  ; 
in  each  variety  differing  from  anything  which  has  been  experienced 
before.  Other  women,  again,  feel  nothing  at  first  beyond  what  is  often 
described  as  an  internal  “fluttering,”  as  if  a  small  bird  were  moving 
its  wings  within  the  body.  In  some  cases  of  this  kind,  the  sensation  is 
so  very  little  perceptible  at  first,  that  the  mother  cannot  fix  definitely 
the  date  at  which  it  was  first  recognized  ;  while  in  others  the  first  per¬ 
ception  is  striking,  and  clearly  appreciable.  The  date  of  pregnancy  at 
which  this  first  impression  of  movement  of  the  child  occurs  is  some¬ 
what  variable.  In  the  majority  of  cases  it  is  not  experienced  before 
the  end  of  the  fourth  month,  and  a  common  period  of  its  occurrence  is 
after  the  lapse  of  four  and  a  half  months  from  the  commencement  of 
pregnancy,  thus  indicating  that  the  middle  of  the  period  of  gestation 
has  been  attained.  But  in  not  a  few  instances  it  is  experienced  at  a 
considerably  earlier  time  ;  at  any  time  after  three  months  of  gestation 
it  may  be  looked  for  ;  and  a  few  women,  more  especially  in  second  or 
later  pregnancies,  are  conscious  of  movements  shortly  after  the  end  of 
the  second  month  has  been  reached.  On  the  other  hand,  some  women 
are  never  conscious  of  the  movements  of  the  child  during  the  whole 
course  of  pregnancy,  although  to  a  doctor  examining  them  the  move¬ 
ments  may  be  perfectly  apparent. 


MOVEMENTS  OF  THE  CHILD. 


27 


After  the  first  sensation  of  movement  has  been  felt,  it  is  usual  to 
be  conscious  of  similar  feelings  throughout  the  whole  of  the  remainder 
of  gestation.  The  movements  of  the  child  become  progressively 
stronger  as  it  grows  within  the  womb,  and  the  sensations  consequently 
more  apparent.  They  may  be  felt  only  at  long  intervals,  days  some¬ 
times  elapsing  without  much  appreciable  movement,  or  they  may  be 
almost  continuously  present. 

It  is  probable  that  only  the  more  violent  movements  of  the  child 
are  felt  by  the  mother,  and  that  almost  constantly  slighter  movements 
are  going  on  of  which  she  is  not  cognizant.  But  different  children 
certainly  vary  very  considerably  as  to  the  amount  of  notice  they 
attract  to  themselves  in  this  way  ;  and  conversely  different  mothers 
present  striking  contrasts  in  the  extent  to  which  they  are  incommoded 
by  these  movements.  After  six  or  seven  months  have  elapsed,  the 
movements  can  often  be  seen  in.  the  changes  of  projection  they  produce 
on  the  surface  of  the  abdomen  ;  and  they  can  be  felt  very  distinctly  by 
the  hand  placed  flatly  against  the  skin  over  the  womb.  When  the 
movements  are  at  all  marked,  they  afford  an  absolutely  certain  indica¬ 
tion  of  the  presence  of  a  living  child  in  the  womb  ;  and  even  when  not 
very  well  marked,  they  are  not  apt  to  be  mistaken  for  anything  else. 
It  must  be  conceded,  however,  that  not  unfrequently  women  very 
anxious  for  children  are  prone  to  imagine  that  they  feel  movements, 
even  in  the  absence  of  any  pregnancy. 

The  indication  of  the  period  of  gestation  reached  is  only  moder¬ 
ately  reliable,  as  the  first  sensation  of  movement  may  be  felt  at  any 
time  between  the  third  month  and  the  date  of  confinement ;  but,  read 
along  with  the  following  sign,  a  considerably  greater  degree  of  accuracy 
can  be  reached. 

Increase  in  Size  of  Abdomen. — In  most  women  during  the  first 
three  months  of  pregnancy,  no  increase  of  size  whatever  is  observable  ; 
in  fact,  in  not  a  few  there  is  an  apparent  slight  diminution  in  the  usual 
curve  of  the  abdominal  walls.  The  reason  of  this  is  that  during  the 
first  three  months  of  pregnancy  the  womb  lies  below  the  level  of  the 
lowej*  part  of  the  abdomen,  only  rising  above  this  between  the  third 
and  fourth  months.  At  that  stage,  unless  women  are  exceptionally 
stout,  there  is  usually  noticeable  a  slight  increase  in  fulness  and  size, 
in  well-nourished  women  fairly  uniform  over  the  whole  of  the  lower 
part,  in  thin  women,  projecting  more  in  the  middle  and  less  at  the 
sides.  In  thin  women  generally  the  projection  can  be  felt  as  a  distinct 
oval  swelling  at  the  lower  part  of  the  abdomen,  varying  in  size  at  the 
end  of  the  fourth  month  from  a  cricket-ball  to  an  ostrich’s  egg. 

After  the  increase  in  size  has  once  become  apparent,  it  progresses 
pretty  uniformly,  and  very  obviously  ;  so  that  by  the  end  of  the  sixth 
month  of  gestation  the  fulness  extends  quite  up  to  the  navel,  and  the 


28 


SIGNS  OF  PREGNANCY. 


prominence  of  the  abdomen  is  marked.  The  increase  in  size  is  caused 
not  only  by  the  continual  growth  of  the  infant,  but  also  by  an  increase 
in  the  quantity  of  the  fluid  which  surrounds  the  child  inside  the  womb. 
Variations  in  size  in  different  women  depend  largely  upon  variations  in 
the  quantity  of  this  fluid  ;  but,  in  addition  to  this,  the  different  figures 
of  women  undoubtedly  result  in  great  differences  in  the  amount  of  vis¬ 
ible  enlargement.  During  the  seventh  and  eighth  months,  the  figure 
continues  to  enlarge,  the  projection  rising  higher  in  the  abdomen  until 
it  reaches  the  foot  of  the  chest,  where  the  ribs  end,  and  there  is  usually 
some  increase  in  breadth  from  side  to  side,  so  that  even  when  seen  from 
behind,  an  increase  in  size  is  observable.  In  the  last  month  of  preg¬ 
nancy,  increase  of  size  is  not  so  marked  ;  and  frequently  there  is  an 
apparent  diminution  by  a  slight  lowering  of  the  whole  projection,  the 
womb,  about  three  weeks  before  confinement  takes  place,  usually  fall¬ 
ing  downwards  a  little  within  the  abdomen. 

Increase  of  size  alone  is,  of  course,  a  very  uncertain  sign  of  preg¬ 
nancy,  as  it  may  arise  from  many  other  conditions ;  but,  in  combina¬ 
tion  with  the  other  signs  and  symptoms  described  above,  or  with  even 
one  or  two  of  them,  it  is  fairly  diagnostic  of  pregnancy.  When  move 
ments  of  the  child  are  distinctly  appreciated,  the  apparent  extent  of 
enlargement  gives  evidence  of  the  probable  date  of  confinement  within 
a  range  of  six  weeks  at  the  outside  ;  and  in  many  cases  a  doctor  car. 
foretell,  by  one  or  two  examinations  of  size  at  intervals,  much  more 
accurately  than  this  the  date  of  the  termination  of  pregnancy. 

This  concludes  the  list  of  signs  and  symptoms  of  which  it  is  desir¬ 
able  that  every  married  woman  should  be  cognizant.  It  is  hardly 
necessary  to  add  that  in  many  cases  of  pregnancy  some  of  them  will 
not  be  present,  while  others  are  liable  to  be  misunderstood  ;  and  when 
a  doubt  exists,  and  a  desire  for  certainty  in  the  matter  is  felt,  a  trained 
medical  man  is  able  not  only  to  appreciate  at  their  proper  value  the 
signs  which  may  be  apparent  to  the  expectant  mother,  but  also  to  dis 
cover  and  elicit  others  which  may  often  be  sufficient  to  place  the  ques¬ 
tion  beyond  doubt. 


Eugene  Klimsck. 


MOTHERHOOD 


CHAPTER 


IV. 


Management  op  Unpleasant  Disorders  op  Pregnancy. 

Nausea  and  Sickness;  Alleviation  by  Tea;  Breakfast  in  Bed;  Effervescing 
Drinks;  Care  in  Diet;  Heartburn;  Temporary  Means  of  Relief;  Water 
Brash;  Dietary  for  Disorders  of  Digestion  in  Pregnancy;  Constipation; 
Alleviation  by  Diet;  Regular  Habits;  Drugs;  Warm  Water;  Mineral 
Waters;  Salts;  Sulphur;  Licorice  Powder;  Senna;  Enemas;  Method  of 
Administration;  Injection  of  Glycerine;  Special  Syringe  desirable;  Selec¬ 
tion  of  Remedy;  Faintness;  Remedies;  Caution  respecting  Stimulants;  In- 
crease.in  Size  and  Sense  of  Weight;  Arrangement  of  Clothing;  Use  of  Cor¬ 
sets;  Supporting  Belts;  Stretching  of  Skin  of  Abdomen  and  Breasts;  Cause; 
Results;  Pigmentation;  Prevention;  Alleviation;  Swelling  of  Feet  and 
Legs;  Alleviation;  Distention  of  Veins  of  Legs;  Two  Forms;  Description; 
Hereditary  Tendency;  Treatment;  Piles,  Internal  and  External;  Treat¬ 
ment;  Vaginal  Discharge  and  Irritation;  Alleviation;  Use  of  Injections; 
Precautions;  Bathing;  Sleeplessness;  Causes;  Remedies;  Caution  against 
Use  of  Narcotics. 

Horning  Sickness. — The  most  usual  discomfort  associated  with 
pregnancy  is  the  morning  nausea  and  sickness,  which  is  fully  described 
in  the  preceding  chapter.  This  unpleasant  symptom  is  often  much 
alleviated  and  sometimes  altogether  removed  by  taking  a  cup  of  tea  or 
of  milk  in  bed  before  rising.  When  this  is  not  sufficient,  remaining  in 
bed  until  about  an  hour  after  the  usual  breakfast  will  often  be  found 
useful.  Effervescing  drinks,  taken  just  before  rising,  are  sometimes  of 
much  value  ;  a  little  soda  or  seltzer  water,  or,  when  constipation  is 
present,  effervescing  citrate  of  magnesia  or  other  similar  preparation, 
may  be  employed.  When  the  sickness  tends  to  recur  throughout  the 
day,  as  well  as  in  the  morning,  considerable  care  in  diet,  is  necessary. 
Foods  difficult  of  digestion,  such  as  pastry,  cheese,  and  root  vegetables 
as  potatoes,  carrots,  or  turnips,  must  be  either  given  up  altogether,  or 
only  taken  in  great  moderation  ;  and  as  a  rule  the  use  of  all  alcoholic 
beverages,  and  especially  beer  or  ale,  should  be  temporarily  abandoned. 
While  suffering  from  this  affection,  most  women  will  find  that  a.rather 
dry  diet,  consisting  of  whitefish,  poultry,  game,  milk  puddings,  and 
stewed  fruits  will  agree  best  with  them  ;  while  much  fluid  of  any  kind, 
even  tea  and  soups,  will  increase  their  discomfort.  It  will  be  found 
generally  advisable  to  make  the  principal  meal  in  the  middle  of  the 
day,  and  to  take  only  a  very  light  meal  in  the  evening.  This  vrill  be 


30 


DISORDERS  OF  PREGNANCY. 


found  particularly  important  where  heartburn  complicates  and  accom¬ 
panies  the  sickness  and  indigestion. 

[When  nausea  becomes  distressing  or  so  persistent  as  to  impair 
appetite  and  endanger  nutrition,  it  is  well  to  resort  to  medicinal  means 
for  its  alleviation,  and  in  all  but  rare  cases  they  can  be  effectively  pre¬ 
scribed.  Dr.  Foote  can  be  consulted  in  person  or  by  letter  without  fee 
in  such  matters,  or  regarding  any  disturbances  of  the  pregnant  state 
when  a  few  words  of  professional  advice  may  be  desired,  if  a  careful 
reading  of  this  work  has  not  enabled  the  sufferer  to  obtain  a  reasonable 
degree  of  comfort.  See  page  1226.] 

Heartburn  is  a  sensation  of  acidity  and  burning  in  the  pit  of  the 
stomach,  often  accompanied  by  pain  radiating  through  to  the  back 
between  the  shoulders  ;  and  frequently  attended  by  the  rising  into  the 
throat,  and  even  into  the  mouth,  of  a  sour  acrid  fluid.  It  is  most  alle¬ 
viated  by  a  dry,  careful  diet,  such  as  is  described  above  ;  and  is  aggra¬ 
vated  by  indulgence  in  much  sugar  or  sweets  of  any  kind,  and  by  alco¬ 
holic  fluids.  When  heartburn  is  severe,  temporary  relief  can  usually  be 
obtained  by  sipping  slowly  a  solution  of  bicarbonate  of  soda  in  water. 
Half  a  teaspoonful  of  powdered  bicarbonate  of  soda  should  be  dissolved 
in  half  a  tumblerful  of  cold  water  ;  and  this  should  be  taken  in  successive 
teaspoonfuls  every  two  or  three  minutes  until  the  burning  is  relieved. 
This  is  much  better  and  more  effective  than  taking  the  same  quantity 
in  one  dose.  Fluid  magnesia,  such  as  Dinneford’s,  may  be  sipped  in  the 
same  way  as  the  solution  of  soda,  but  is  not  quite  such  a  harmless  or 
efficient  remedy.  Occasionally,  when  these  remedies  fail,  a  little 
slightly  acid  fluid  is  found  beneficial.  Some  patients  obtain  considerable 
relief  from  small  quantities  of  lemon-juice  in  water ;  and  temporary 
abatement  has  followed  sometimes  from  eating  rather  acid  apples. 
The  latter,  however,  is  not  a  very  desirable  remedy  from  other  points 
of  view.  Powdered  chalk  in  small  doses,  as  much  powder  as  can  be 
heaped  on  a  sixpence  [dime]  being  taken  as  a  dose,  is  occasionally  use¬ 
ful  ;  but  if  employed  often  is  apt  to  cause  constipation. 

Water-brash. — Sometimes  in  the  absence  of  heartburn,  a  watery 
fluid  of  a  mawkish  taste,  or  sometimes  tasteless,  is  found  to  rise  into 
the  throat  and  mouth,  and  even  to  run  out  of  the  mouth.  This  affec¬ 
tion  is  known  as  “water-brash/’  and  is  a  not  unfrequent  accompaniment 
of  other  affections  of  the  stomach,  as  well  as  of  those  connected  with 
pregnancy.  It  is  generally  alleviated  by  a  diet  similar  to  that  which  is 
required  when  suffering  from  heartburn.  Below  is  appended  an  out¬ 
line  of  diet  suitable  for  invalids  suffering  from  sickness,  heartburn, 
water-brash,  or  from  any  combination  of  these  affections. 

Dietary  during  Pregnancy. — 1.  Before  rising  in  the  morning,  a 
small  cup  of  recently  infused  tea  (not  allowed  to  stand  for  more  than 
five  minutes)  or  of  milk,  either  warm  or  cold. 


DIETARY  DURING  PREGNANCY. 


31 


2.  For  breakfast,  one  cup  of  recently  infused  tea  or  coffee  made 
with  three  parts  of  milk,  or  thin  cocoa,  made  with  equal  parts  of  boil¬ 
ing  milk  and  water,  toast  or  stale  bread,  an  egg,  or  a  little  fresh  white 
fish,  such  as  sole,  haddock,  or  whiting.  Very  little  butter  should  be 
taken,  no  fresh  rolls,  or  cured  fish  or  meat  of  any  kind. 

3.  For  midday  dinner,  any  kind  of  white  fish,  poultry,  game,  mut¬ 
ton,  and  lamb.  Beef  should  be  taken  in  great  moderation,  pork  not  at 
all.  As  vegetables,  cauliflower,  spinach,  asparagus,  and  early  Brus¬ 
sels  sprouts  are  the  most  eligible  ;  potatoes,  turnips,  carrots,  parsnips, 
and  artichokes  are  to  be  avoided  [if  there  be  any  reason  to  suspect  that 
they  are  difficult  of  digestion,  or  a  cause  of  flatulence].  Milk  pud¬ 
dings  with  a  little  stewed  fruit  may  follow,  but  should  not  have  much 
sugar  added  to  them.  Uncooked  fruits  should  only  be  taken  in  great 
moderation  ;  the  best  are  grapes,  bananas,  and  perhaps  very  ripe  pears, 
apples,  and  oranges. 

4.  In  the  evening,  a  very  light  meal,  consisting  at  most  of  a  little 
white  fish  and  a  milk  pudding,  will  be  found  most  conducive  to  com¬ 
fort  ;  and  it  should  be  taken,  if  possible,  at  least  two  hours  before 
going  to  bed. 

5.  When  attacks  of  faintness  seem  to  render  it  necessary,  a  small 
tumblerful  of  milk  and  a  biscuit  may  be  taken  between  breakfast  and 
dinner  ;  and  there  is  usually  no  objection  to  one  small  cupful  of  tea  in 
the  afternoon,  preferably  with  a  good  deal  of  milk  in  it,  and  accom¬ 
panied  by  a  plain  biscuit  or  rusk. 

When  the  regimen  indicated  above  is  insufficient  to  alleviate  the 
discomforts  of  digestion,  it  will  be  necessary  for  the  patient  to  avail 
herself  of  medical  skill ;  and  fortunately  the  resources  of  medicine  can 
do  much  to  subdue  the  more  unpleasant  manifestations  of  these  gastric 
derangements.  In  some  instances  the  invalid  is  obliged  to  restrict  her¬ 
self  for  a  time  entirely  to  liquid  diet ;  but  this  should  not  be  done 
except  upon  competent  medical  advice.  [On  the  other  hand  there  are 
cases  in  which  a  strictly  dry  diet,  drinking  almost  nothing  with  the 
meals,  and  avoiding  sloppy  foods,  soups,  porridges,  puddings,  etc., 
proves  to  be  a  very  helpful  plan  ;  and,  again,  simplicity  in  diet,  or 
limiting  the  variety  of  food  at  any  one  meal,  is  another  way  of  keeping 
the  stomach  quiet  and  easy.] 

Constipation,  or  confinement  of  the  bowels,  is  an  exceedingly 
common  discomfort,  more  especially  of  the  earlier  part  of  pregnancy. 
While  it  is  perhaps  worse  in  cases  w'liere  vomiting  is  prominent,  it  is 
frequently  present  in  the  absence  of  any  other  symptom  of  disordered 
digestion.  Where  a  healthy  condition  of  the  gastric  digestion  will 
permit  of  it,  much  may  be  done  to  remove  the  constipation  by  a  care¬ 
fully  varied  selection  of  diet.  Many  women  find  that  oatmeal,  taken  in 
the  form  of  porridge  for  breakfast,  has  a  distinctly  stimulating  effect  on 


32 


EARLY  MARRIED  LIFE. 


the  bowel;  and  it  is  an  article  of  diet  which  many  appreciate  and 
enjoy.  Oatmeal  may  also  he  taken  in  the  form  of  oatmeal  cakes  or 
biscuits  at  other  times.  Again,  the  use  in  some  quantity  of  green  veg¬ 
etables,  such  as  cabbage,  spinach,  Brussels  sprouts,  or  turnip-tops,  has 
a  strong  influence  in  removing  constipation,  and  assisting  regular  action 
of  the  bowels.  Stewed  fruits  also,  more  especially  perhaps  figs  and 
prunes,  are  beneficial  in  this  way,  and  valuable  articles  of  food  from 
other  points  of  view. 

It  is  most  important,  at  the  same  time  that  one  studies  diet  for  the 
purpose  of  removing  constipation,  to  make  a  regular  practice  of  solicit¬ 
ing  an  action  of  the  bowels  at  the  same  hour  every  day,  and  to  give  a 
sufficient  time  for  this  purpose.  Just  as  one  acquires  a  habit  of  being 
hungry  at  certain  hours  of  the  day  associated  with  meals,  and  becom¬ 
ing  sleepy  at  an  hour  associated  with  rest,  so  one  can  acquire  the  habit 
of  feeling  the  want  of  relief  of  the  bowels  at  a  certain  hour  ;  and  the 
habit  being  acquired,  the  bowels  are  more  likely  to  act  at  that  time 
than  at  any  other.  There  is  no  doubt  that  both  sickness  and  heartburn 
during  pregnancy  are  much  aggravated  by  constipation,  so  that  the 
presence  of  these  symptoms  is  an  additional  reason  for  giving  both  time 
and  attention  to  the  due  performance  of  this  function  of  Nature. 

When  the  diet  indicated  above,  and  the  regular  solicitation  of  the 
bowels  are  insufficient  to  effect  the  desired  result,  it  is  necessary  to 
resort  to  some  simple  means  of  stimulating  the  bowel  to  increased 
action.  This  can  be  done  in  two  ways,  either  by  taking  some  drug  by 
the  mouth,  which  will  act  on  the  bowel  indirectly ;  or  by  applying 
some  stimulus  to  the  interior  of  the  bowel  itself.  Each  method  of 
action  is  eligible  under  varying  circumstances. 

[The  Magnetic  Anti-bilious  Tablets,  No.  3,  on  list  of  Sanitary 
Bureau  remedies  (see  page  1228),  provide  a  handy  form  of  gentle  laxa¬ 
tive  suitable  for  use  during  pregnancy.] 

When  there  is  no  troublesome  morning  sickness,  many  women  find 
that  a  tumblerful  of  hot  water,  taken  on  rising  from  bed  every  morning, 
is  sufficient  to  produce  an  action  of  the  bowels  after  breakfast.  It 
should  be  taken  as  warm  as  can  be  comfortably  drunk,  and  should  be 
sipped  slowly  during  dressing.  The  addition  of  a  little  fresh  lemon- 
juice  makes  the  water  certainly  more  palatable,  and  probably  some 
what  more  efficacious.  When  this  is  not  found  sufficient,  the  addition 
of  a  wine-glassful  of  one  or  other  of  the  numerous  natural  mineral  purga¬ 
tive  waters  to  the  tumblerful  of  warm  water,  will  often  be  effective  and 
not  very  unpleasant  to  taste.  The  ingredients  of  some  of  these  waters 
are  now  sold  as  effervescent  salts,  which  can  be  added  to  warm  water 
and  taken  while  effervescing.  These  are  conveniently  portable  forms 
of  the  remedies.  When  sickness  in  the  morning  prevents  the  employ¬ 
ment  of  the  remedies  just  mentioned,  or  when  they  do.  not  prove  effec- 


CONSTIPATION  OF  PREGNANCY. 


33 


Fig.  2. 


tive,  some  laxative  drug  may  be  taken  at  night ;  and  among  the  more, 
commonly  used  of  these  may  be  mentioned  a  teaspoonful  of  compound 
licorice  powder,  or  of  electuary  of  senna,  either  of  which  may  be 
taken  nightly  when  required.  [Among  laxative  pills  that  may  be 
recommended  Dr.  Foote’s  Magnetic  Vegetable  Anti-bilious  Pills  arc 
effective,  moderate  in  action,  and  suitable  for  constipation  during 
pregnancy.  See  page  1228.] 

When  medicines  of  this  nature  are  ineffective,  or  when  their  action 
is  accompanied  by  discomfort  or  pain,  recourse  may  be  had  to  direct 
stimulation  of  the  lower  bowel  either  by  enemas  of  plain  warm  water, 
or  by  injections  of  glycerine,  or  by  the  use  of  glycerine  suppositories. 

Enemas  of  warm  water,  while  very  useful  and  harmless  when 
employed  only  occasionally,  are  not  eligible  for  habitual  constipation. 
In  many  circumstances,  however,  they  can  be  used  to  give  immediate 
relief,  and  it  is  desirable  for  every  woman  to  be  familiar  with  the  man¬ 
ner  of  their  employment.  For  the  administra¬ 
tion  of  an  enema  some  kind  of  syringe  is  neces¬ 
sary.  The  one  which  is  most  commonly  used 
for  this  purpose,  and  which  is  eligible  both  on 
account  of  its  low  price  and  the  simplicity  of  its 
construction  is  known  as  The  Family  Enema, 

Syringe  (see  Fig.  2).  It  consists  essentially  of  an  rAMIET  ENEMA  8TWNQE. 
india-rubber  tube  with  an  enlargement  in  the 

middle,  and  a  valve  near  either  end  which  allows  of  fluid  to  pass  only 
in  one  direction.  The  end  which,  in  use,  is  immersed  in  the  fluid  is 
usually  slightly  weighted  ;  the  other  end  is  a  hard  rubber  or  metal 
nozzle,  about  two  inches  long.  Accompanying  the  syringe  as  described 
above,  is  usually  sold  an  additional  longer  nozzle  made  of  hard  rubber 
which  can  be  slipped  on  to  the  rubber  tube  when  the  syringe  is  required 
for  other  purposes,  to  be  described  later  on.  The  price  of  this  syringe 
varies  from  about  one  to  three  dollars,  according  to  the  quality  of  the 
india-rubber  of  which  it  is  made.  [See  page  1227.]  It  is  usually  sold 
enclosed  in  a  box  ;  but  it  is  better  to  keep  it  lying  loosely  in  a  drawer, 
as  the  curving  to  which  it  is  subjected  in  fitting  into  tbe  box  is  apt  in 
time  to  damage  the  india-rubber.  Its  mode  of  action  is  very  simple.  If 
a  basin  of  water  be  taken,  and  the  end  farthest  from  the  nozzle  be  put 
into  the  water,  by  pressing  with  one  hand  the  enlarged  ball  in  the  cen¬ 
tre  and  relaxing  the  pressure  two  or  three  times  successively,  the  water 
will  be  made  to  circulate  through  the  tube  and  emerge  from  the  end  of 
the  nozzle.  The  rapidity  and  force  with  which  the  stream  emerges 
will  depend  on  the  amount  of  pressure  applied  to  the  ball,  and  the  fre¬ 
quency  of  the  alternations  of  pressure  and  relaxation. 

In  administering  an  enema  the  fluid  to  be  injected  is  put  into  ai- 
basin  or  jug,  and  the  weighted  end  of  the  syringe  dropped  into  it.  By 
2 


34 


DISORDERS  OF  PREGNANCY. 


one  or  two  acts  of  pressure  and  relaxation  of  the  hand  applied  to  the 
ball,  the  syringe  is  filled  with  the  fluid,  until  it  is  seen  to  begin  to 
emerge  from  the  nozzle.  The  nozzle  should  be  then  coated  with  a 
little  vaseline  or  sweet  oil,  and  gently  pushed  straight  into  the  entrance 
of  the  bowel,  as  far  as  it  will  go.  There  is  usually  a  small  collar  round 
the  top  of  the  nozzle  where  it  joins  the  india-rubber  tubing,  and  the 
nozzle  should  be  pushed  into  the  bowel  until  this  collar  presses  against 
the  entrance.  If  the  introduction  is  effected  gently,  it  should  produce 
no  pain,  nor  even  discomfort.  When  the1  nozzle  has  been  inserted,  the 
ball  of  the  syringe  is  compressed  and  relaxed  alternately  until  the 
whole  of  the  fluid  is  injected  into  the  bow'el. 

The  fluid  most  commonly  used  as  an  injection  is  warm  water,  of 
such  a  temperature  as  can  be  quite  comfortably  borne  by  the  hand 
immersed  in  it.  When  an  injection  slightly  more  stimulating  is  desired, 
occasionally  some  soap  is  rubbed  down  in  the  warm  water  before  use. 
Sometimes  thin  gruel  is  used  as  an  injection,  in  combination  with  a 
wine-glassful  of  olive-oil,  or  half  that  quantity  of  castor-oil.  The 
quantity  of  fluid  used  for  one  injection  is  usually  from  a  pint  to  a 
quart ;  but  occasionally  even  more  than  a  quart  may  be  injected.  It 
will  be  found  that  the  greater  the  quantity  that  can  be  injected,  the 
more  efficient  the  resulting  relief  of  the  bowels  will  be ;  and  there  is 
no  risk  whatever  of  injecting  too  much,  as,  when  the  bowel  cannot 
contain  what  is  injected,  it  will  always  be  pressed  out  at  the  side  of  the 
nozzle  before  it  is  withdrawn.  The  four  points  requiring  attention  in 
administering  an  injection  satisfactorily  are — 

First,  the  proper  introduction  of  the  nozzle  ; 

Second,  the  slow  administration  of  the  fluid  ; 

Third,  the  occasional  cessation  of  administration  for  a  minute  or 
two,  if  it  is  felt  that  it  is  setting  up  action  too  quickly  ; 

And  fourth,  the  retention,  if  possible,  of  the  fluid  for  a  few  min¬ 
utes  after  the  nozzle  is  withdrawn. 

The  person  receiving  the  injection  will  often  feel  after  a  small 
quantity  has  been  injected  as  if  it  were  impossible  to  retain  it  or  receive 
more  ;  but  in  one  or  two  minutes,  if  the  action  of  the  syringe  is  inter¬ 
mitted,  the  bowel  will  again  relax  and  receive  the  remainder.  When 
as  much  has  been  injected  as  can  possibly  be  retained,  the  nozzle  is 
withdrawn,  and  the  withdrawal  is  followed  almost  immediately  by 
relief  of  the  contents  of  the  bowel,  along  with  the  fluid  which  has  been 
injected. 

Injection  of  Glycerine. — A  very  convenient  method  of  obtaining 
action  of  the  bowels  without  recourse  to  laxative  medicine  is  found  in 
the  administration  of  a  little  glycerine.  It  is  found  that  the  injection 
of  one  or  two  teaspoonfuls  of  glycerine  within  the  entrance  of  the 
bowel  is  followed  usually  within  ten  or  fifteen  minutes  by  relief  of  the 


FAINTNESS.  35 

bowels.  A  special  small  syringe  is  necessary  for  this  purpose,  as  the 
family  syringe  is  scarcely  suitable  for  the  injection  of  such  a  small 
quantity  as  one  teaspoonful.  The  most  convenient  syringe  for  the  pur- 
pose  is  one  made  of  vulcanite,  just  large  enough  to  hold  the  quantity 
required.  One  such  as  is  illustrated  here  (Fig.  3)  can  be  obtained  from 
any  chemist  at  a  very  small  cost.  The  syringe  is  tilled  by  inserting  the 
nozzle  into  the  glycerine,  and  pulling  out  the  piston ;  the  nozzle  is 
then  gently  pushed  into  the  entrance  of  the  bowel  for  an  inch  or  more, 
and,  by  pressing  the  piston,  the  glycerine  is  injected  within  the  bowel. 
Self-administration  is  very  simple  and  easy  ;  and  as  the  auction  of  the 
glycerine  is  that  of  a  local  stimulant,  there  seems  to  be  no  objection  to 
the  frequent  repetition  of  the  remedy  when  called  for  by  constipation. 
It  is  not,  however,  equally  effective  with  every  one  ;  while,  on  the 
other  hand,  the  large  injection  of  fluid  with  the  family  syringe  is 
always  more  or  less  effective  ;  but  as  the  latter  acts  chiefly  by  mechan- 

Fig.  3. 


GLYCERINE  SYRINGE. 

ical  distention,  its  too  frequent  use  is  apt  to  be  followed  by  permanent 
weakening  and  dilatation  of  the  lower  end  of  the  bowel.  The  glycerine, 
instead  of  dicing  injected  by  a  syringe  into  the  bowel,  is  occasionally 
made  into  a  gelatinous  suppository  by  the  addition  of  gelatine  ;  and  the 
suppository,  coated  with  olive-oil,  is  pushed  into  the  entrance  of  the 
bowel  with  the  finger.  In  this  form  also  it  acts  with  considerable 
efficacy. 

Faintness. — The  occasional  sensation  of  faintness,  which  not  un- 
frequently  is  experienced  in  the  earlier  months  of  pregnancy,  is  best 
combated  by  lying  down  for  a  few  minutes,  and  sipping  slowly  some 
fluid  food.  Cold  water  is  often  quite  sufficient  for  the  purpose,  the 
essentiaTpoint  being  the  slow  sipping,  which  acts  as  a  temporary  stim¬ 
ulant  to  the  heart ;  but  milk,  or  beef-tea,  or  soup  may  be  taken  when 
preferred.  When  there  is  a  tendency  to  hysteria  along  with  the  faint¬ 
ness,  half  a  teaspoonful  of  aromatic  spirits  of  ammonia  in  a  small  wine- 
glassful  of  water  is  useful.  [It  is  a  prompt  acting  stimulant  which 
does  not  create  a  longing  for  habitual  indulgence.]  It  is  most  im¬ 
portant  that  [alcoholic]  stimulants  should  not  be  resorted  to  lor  the 
relief  of  this  symptom.  Although  they  may  temporarily  remove  it,  they 
predispose  to  its  occurrence,  and  are  apt  to  intensify  any  otliei  discom¬ 
forts  which  may  be  present,  as  well  as  to  do  injury  in  other  ways. 


36 


DISORDERS  OF  PREGNANCY. 


Increase  in  Size,  and  Sense  of  Weight. — After  the  end  of  the 

third  month  of  pregnancy,  a  slight  increase  in  size  is  usually  percepti¬ 
ble,  and  it  is  not  uncommon  to  have  a  sense  of  having  some  little  weight 
to  support.  It  is  most  important,  from  this  time  onwards,  that  no 
pressure  from  undue  tightness  of  clothing  should  interfere  with  the 
proper  and  normal  ascent  of  the  womb  within  the  abdomen.  Gener¬ 
ally  speaking,  corsets  can  be  worn  with  comfort  up  to  the  end  of  the 
sixth  month  of  pregnancy,  if  care  be  taken  to  adjust  them  to  the  size 
required  ;  and  often  a  well-adjusted  corset  will  afford  considerable 
support.  But  all  compression  of  the  waist  must  be  avoided  ;  find  as 
far  as  possible  any  heavy  clothing  worn  should  be  suspended  from  the 
shoulders  rather  than  from  the  waist.  When  any  sense  of  weight  is 

....  f  .... 

Fig.  4.  Fig.  5. 


ABDOMINAL  BELTS. 

experienced,  much  relief  and  comfort  are  often  obtained  from  wearing, 
below  the  corset,  a  belt  which  will  support  the  lower  part  of  the  abdo¬ 
men.  A  sketch  is  appended  of  a  belt,  which  fulfils  this  purpose  very 
satisfactorily  (Fig.  4).  [See  page  1227.] 

After  the  completion  of  six  months  of  pregnancy,  most  women  will 
find  that  tlicir  comfort  is  increased  by  giving  up  the  wearing  of  cor¬ 
sets.  When  a  sense  of  weight,  or  a  dragging  at  the  sides  is  felt,  a  belt 
somewhat  larger  than  the  one  described  above  will  be  found  helpful. 
A  sketch  is  annexed  (Fig.  5)  of  a  belt  of  the  shape  most  useful ;  most 
women  who  have  some  skill  in  the  use  of  a  needle  would  be  able  to  make 
one  for  themselves  of  similar  design,  at  comparatively  little  cost.  The 
best  material  of  which  to  make  a  belt  of  this  kind  is  either  calico,  or 
strong  towelling  ;  and  the  belt  should  be  gored  slightly  in  front  to  fit 
the  figure,  and  stiffened  with  one  or  two  strips  of  thin  whalebone,  or 
one  or  two  skeins  of  cotton,  inserted  between  two  layers  of  the  mate¬ 
rial  selected.  It  is  generally  most  convenient  to  make  it  fasten  at  one 


STRETCHING  OF  SKIN. 


37 


side,  not  at  the  back,  and  the  best  fastening  is  by  straps  and  buckles. 
Belts  of  more  or  less  similar  character  for  this  purpose  are  sold  by 
almost  all  surgical  instrument  makers. 

Stretching  of  Skin  of  Abdomen  and  Breasts. — The  elasticity 
of  the  skin  covering  the  abdomen  varies  greatly  in  different  women. 
In  the  later  months  of  pregnancy  it  is  subjected  to  considerable  stretch¬ 
ing  ;  and  this  very  frequently  results  in  some  alteration  in  the  appear¬ 
ance  of  the  skin.  Whitish  lines,  from  a  quarter  of  an  inch  to  an  inch 
broad,  of  more  glistening  appearance  than  the  surrounding  skin,  are 
seen  slanting  from  the  sides  of  the  abdomen  toward  the  middle  line  at 
intervals  of  one  or  two  inches  ;  and  these  lines  tend  to  increase  in 
width  and  length  as  pregnancy  advances.  They  are  known  to  phy¬ 
sicians  by  the  Latin  name  of  linice  albicantes,  and  give  a  very  distinct 
impression  of  skin  stretched  beyond  its  elastic  power,  just  as  india- 
rubber  might  be  overstretched.  When  they  appear  in  persons  of  dark 
complexion,  the  white  color  is  usually  replaced  by  a  brown  pigment, 
and  they  are  found  as  darker  colored  streaks  on  the  natural  skin. 
When  once  clearly  produced,  they  very  seldom  disappear  entirely  in 
afterlife,  although  after  confinement  they  become  much  narrower  and 
less  distinct.  Usually,  in  a  few  months  after  confinement,  they  become 
entirely  white,  even  in  cases  where,  before  confinement,  they  have  been 
deeply  colored,  and  remain  as  white  streaks  on  the  abdomen  through¬ 
out  life,  affording  often  a  reliable  indication  of  the  previous  occurrence 
of  pregnancy.  Similar  lines,  although  very  much  smaller,  occasionally 
occur  on  the  breasts  when  much  distended  with  milk.  As  this  disten¬ 
tion  only  happens  writh  most  women  after  childbirth,  the  streaks  are 
only  formed  after  the  confinement  has  taken  place  ;  but  in  those  cases 
where  milk  is  present  in  considerable  abundance  before  the  birth  of 
the  child,  these  lines  may  be  found  at  a  late  period  of  the  pregnancy. 
The  lines  on  the  breasts,  as  on  the  abdomen,  are  usually  permanent  in 
afterlife  ;  but  if  they  are  only  slight  they  may  disappear  without  leav¬ 
ing  traces.'  The  formation  of  these  lines  on  the  skin  of  the  abdomen  is 
sometimes  accompanied  by  some  sense  of  discomfort  and  even  pain, 
which  is  described  as  a  sensation  of  stretching  and  dragging. 

Their  appearance  on  the  abdomen  may  sometimes  be  entirely  pre¬ 
vented  by  wearing  continuously  a  belt  such  as  has  been  described 
above  ;  and  in  cases  where  the  distention  of  skin  is  too  great  to  admit 
of  prevention,  the  wearing  of  the  belt  will  usually  diminish  their  extent 
and  size,  and  will  also  much  alleviate  any  suffering  hicli  they  may 
cause.  There  is  some  reason  to  think  that  the  inunction  of  oil,  such  as 
olive  or  linseed  oil,  increases  the  elasticity  of  the  skin  ;  and  as  they  aie 
perfectly  harmless  applications,  it  is  well,  on  the  slightest  appeal  ant  e 
of  stretching,  to  rub  into  the  skin,  morning  and  evening,  one  of  those 
oils.  The  inunction  is  also  useful  in  the  alleviation  ot  discomfoit. 


DISORDERS  OF  PREGNANCY. 


3* 

[Dr.  Foote’s  Magnetic  Ointment  is  an  oily  preparation  with  special 
soothing  properties  that  render  it  of  great  service  in  many  ways  to  the 
parturient  woman,  and  especially  during  the  later  stages  of  pregnancy, 
and  for  the  relief  of  abdominal  and  vaginal  soreness  following  labor. 
It  is  effective  in  preventing  caking  and  soreness  of  the  breasts,  and 
there  is  nothing  equal  to  it  for  tender  or  cracked  nipples.  See  page 
1228.] 

To  the  breasts  it  is  more  difficult  to  apply  treatment.  There  is  no 
objection  to  the  gentle  rubbing  with  olive-oil ;  but  any  undue  pressure 
upon  them  to  prevent  enlargement  might  injure  the  secretion  of  milk, 
besides  possibly  doing  harm  in  other  ways.  In  cases  where  a  loose 
corset  can  be  worn  with  comfort  during  the  later  months  of  pregnancy, 
t  he  support  of  the  breasts  on  pads  within  the  corset  may  assist  in  prevent¬ 
ing  excessive  stretching  ;  for  the  stretching  is  generally  more  noticeable 
on  the  upper  than  on  the  under  surface  of  the  breasts.  Pads  for  the 
purpose  can  be  easily  made  of  cotton-wool  covered  with  linen,  and 
stitched  inside  the  upper  part  of  the  front  of  the  corset. 

Swelling  of  Feet  and  Legs  is  a  not  unfrequent  source  of  incon¬ 
venience  in  the  later  months  of  pregnancy.  It  is  generally  due  to  the 
pressure  of  the  womb,  as  it  increases  in  size  in  the  abdomen,  on  the 
veins  which  convey  the  blood  returning  from  the  legs,  the  circulation 
being  thus  impeded.  When  the  swelling  is  slight  and  confined  to  the 
feet  and  ankles,  it  is  not  usually  of  much  importance,  nor  does  it  give 
much  annoyance.  But  when  considerable,  and  extending  up  to  or 
beyond  the  knee,  it  not  only  impairs  to  some  extent  the  walking 
powers,  but  also  produces  a  sense  of  heaviness  and  fatigue.  The  main 
importance  of  the  existence  of  swelling  in  the  feet  and  legs  is,  that  it 
is  in  some  cases  an  indication  of  the  presence  of  some  congestion  of  the 
kidneys,  which  is  apt  to  lead  to  future  harm  if  not  attended  to.  So 
long  as  the  swelling  of  the  feet  and  legs  is  slight,  so  long  as  there  is 
no  swelling  of  the  eyelids  or  other  parts  of  the  face,  while  the  general 
health  remains  good,  and  the  quantity  of  urine  normal  in  amount  and 
color,  the  patient  need  not  have  any  anxiety  about  the  existence  of  this 
symptom;  but  if  the  swelling  is  considerable  in  the  legs,  and  appears 
at  all  in  the  face,  it  is  very  desirable  that  she  should  consult  a  medical 
man  on  the  matter. 

In  the  slighter  cases,  the  use  of  a  belt  to  support  the  womb  often 
relieves  the  pressure  on  the  veins  sufficiently  to  obviate  the  swelling  of 
the  legs  ;  and  if  that  does  not  suffice,’  raising  the  legs  on  a  chair  while 
resting,  or  lying  on  a  couch  for  one  or  two  hours  daily,  will  prevent  any 
discomfort.  Gentle  rubbing  upwards  of  the  legs  for  a  quarter  of  an 
hour,  once  or  twice  a  day,  will  much  assist  in  reducing  swelling.  Sim¬ 
ple  slight  swelling  of  the  legs  should  never  be  an  excuse  for  omitting 
one’s  usual  exercise. 


DISTENDED  AND  VARICOSE  VEINS. 


39 


Distention  of  the  Veins  of  the  Legs  sometimes  occurs  as  a 
further  result  of  pressure  upon  the  veins,  which  conduct  the  blood  from 
the  legs.  It  is  met  with  in  two  forms.  More  generally,  there  is  an  in¬ 
crease  in  size  of  all  the  smaller  veins  in  the  skin  of  some  part  of  the 
leg,  so  that  the  course  of  each  small  vein  can  be  distinctly  seen,  and  the 
leg  is  covered  with  a  net-work  of  reddish-blue  blood-vessels.  Such 
general  increase  in  size  is  apt  to  occur  in  patches  in  different  parts  of 
the  leg — the  inner  and  outer  sides  of  the  thighs,  and  the  inner  side  of 
the  leg.  and  ankle  being  frequent  sites.  The  surface  of  the  skin  over 
them  is  smooth,  and  there  are  no  projecting  veins  forming  swellings  on 
the  skin. 

In  the  other  form,  one  or  two  large  veins  are  enlarged  and  swollen, 
and  form  projecting  and  discolored  lines  along  the  legs  and  thighs. 
The  lines  are  of  a  deep  blue  color,  and  are  somewhat  tortuous ;  one 
may  often  be  traced  continuously  from  the  ankle  to  the  top  of  the 
thigh.  When  they  are  very  conspicuous,  they  are  usually  more  or  less 
knotted  as  well  as  tortuous  ;  and  are  always  worst  in  the  inside  of  the 
leg  and  thigh,  although  occasionally  found  as  well  on  the  outside. 

To  this  second  form  more  particularly  the  name  of  varicose  veins 
is  usually  given.  The  two  forms  may  be,  and  often  are,  found  together 
in  the  same  person.  Those  distended  and  varicose  veins  are  not  by 
any  means  peculiar  to  pregnancy.  The  tendency  to  them  is  usually 
hereditary,  and  has  probably  some  relation  to  the  inherited  diathesis 
of  gout  and  rheumatism.  But  this  tendency  may  be  dormant  until 
excited  by  some  cause,  and  pregnancy  is  undoubtedly  one  of  the  most 
frequent  exciting  causes  of  distended  and  varicose  veins  in  women.  As 
the  majority  of  women  escape  this  discomfort  even  after  repeated 
pregnancies,  it  is  probable  that  pregnancy  of  itself,  in  the  absence  of 
any  hereditary  tendency,  is  not  sufficient  to  cause  this  condition  of 
veins.  In  many  instances,  even  when  the  distention  is  considerable, 
complete  recovery  follows  the  confinement,  recovery  being  more  fre¬ 
quent  in  the  first  than  in  the  second  description. 

When  either  form  appears,  its  extension  can  often  be  prevented  by 
attention  and  care.  As  in  the  case  of  swollen  legs,  the  use  of  a  belt, 
and  occasional  resting  with  the  feet  elevated,  will  go  far  to  relieve  the 
pressure  upon  the  veins.  Special  attention  to  the  regular  action  of  the 
bowels  is  also  of  much  importance  ;  and  even  where  there  is  a  natural 
daily  action,  it  is  usually  of  advantage  to  take  some  mild  aperient  med¬ 
icine  once  or  twice  a  week.  Regular  exercise  is  also  of  great  use  in 
distention  of  the  veins.  The  muscular  action  of  the  leg  involved  in 
walking  is  markedly  beneficial  in  assisting  the  circulation  of  the  veins, 
and  obviating  the  tendency  to  varicosity.  On  the  other  hand,  standing 
still  or  sitting  with  the  legs  hanging  down  is  prejudicial ;  and  if  the 
distended  veins  are  present  in  the  leg  as  well  as  in  the  thigh,  it  ifl 


4o 


DISORDERS  OF  PREGNANCY, 


\ 


always  well  to  rest  with  the  legs  supported  on  a  chair  or  on  a  sofa.  If 
the  distended  veins  are  present  only  in  the  thigh,  there  is  not  the  same 
objection  to  sitting  with  the  legs  hanging  down  ;  but  standing  should 
be  avoided. 

When  the  second  form  of  distention  exists — in  other  words,  when 
varicose  veins  are  present,  it  is  desirable  to  support  them  by  the  exter¬ 
nal  pressure  of  a  bandage  or  an  elastic  stocking.  If  a  bandage  is  em¬ 
ployed,  the  best  material  is  thin  flannel,  or  domette ;  thin  calico  also 
may  be  used.  At  whatever  part  of  the  leg  the  varicose  vein  may  be 
situated,  the  bandaging  must  be  commenced  at  the  foot  and  carried 
upwards  to  a  point  one  or  two  inches  above  the  upper  end  of  the  vari- 
cosed  part.  The  most  convenient  width  for  a  bandage  is  three  inches, 
and  the  length  will  depend  upon  the  height  to  which  the  limb  is  to  be 
bandaged.  If  only  to  below  the  knee,  a  bandage  of  five  yards  long 
will  be  sufficient ;  if  it  is  to  be  carried  half-way  up  the  thigh,  about 
nine  yards  will  be  required  ;  while  if  the  whole  of  the  thigh  as  well  as 
the  leg  requires  support,  a  bandage  of  twelve  yards  will  be  necessary. 
Generally,  the  bandage  may  be  left  off  at  night  on  going  to  bed,  and 
put  on  before  rising  in  the  morning  ;  but  there  is  no  objection  to  its 
being  worn  all  night  if  comfort  is  derived  from  its  use. 

.  Elastic  stockings  must  be  obtained  from  a  maker,  and  are  usually 
made  to  measure.  They  can  be  had  in  two  materials,  silk  and  cotton  ; 
and  different  qualities  of  each  of  these  materials  are  met  with.  The 
silk  are  the  more  expensive,  but  are  more  durable  and  more  comforta¬ 
ble  than  the  cotton  ones.  The  durability,  however,  is  not  of  so  much 
importance  when  worn  during  pregnancy,  as  it  will  generally  be  found 
that  the  stocking  worn  during  pregnancy  will  be  too  large  to  be  of  use 
after  confinement,  so  that,  if  required  at  all  afterwards,  a  smaller  one 
must  be  obtained.  [By  sending  proper  measurements,  elastic  stockings 
can  be  obtained  by  mail  from  the  Sanitary  Bureau.  See  page  1227.] 

Elastic  stockings  are  injured  by  being  worn  at  night ;  they  should 
therefore  be  taken  off  on  going  to  bed,  and  put  on  before  rising  in  the 
morning.  If  any  support  is  required  for  the  veins  at.  night,  a  bandage 
should  be  used  ;  the  stocking  being  removed,  and  the  bandage  put  in 
its  place  while  lying  down. 

Piles  or  Haemorrhoids  are  often  the  cause  of  considerable  dis¬ 
comfort  during  pregnancy,  appearing  at  a  very  early  stage,  and  contin¬ 
uing  more  or  less  throughout  the  whole  course.  The  predisposition  to 
piles  is  hereditary,  and  is  closely  associated  with  the  tendency  to  vari¬ 
cose  veins  in  the  legs  ;  in  fact,  in  their  commencement,  piles  are  really 
small  varicose  veins  in  the  neighborhood  of  the  opening  of  the  bowels. 
They  appear,  liQwever,  often  during  pregnancy  in  patients  who  have 
bo  hereditary  predisposition  to  their  occurrence,  their  appearance  being 
due  in  many  cases  to  constipation. 


PILES  OR  HEMORRHOIDS. 


41 


Piles  are-  met  with  in  two  forms.  In  the  first,  which  are  called 
internal  piles,  there  is  nothing  to  be  seen  on  external  examination, 
and  their  presence  is  usually  indicated  by  the  appearance  of  a  little 
blood  after  the  bowels  have  been  moved.  Frequently,  also,  some 
streaks  of  blood  will  be  found  on  the  motions.  The  amount  of  blood 
lost  after  the  motion  of  the  bowels  varies  very  much  in  different  per¬ 
sons,  seldom  probably  exceeding  one  or  two  tablespoonfuls,  and  in  many 
cases  not  amounting  to  more  than  one  teaspoon ful.  If  the  motion  is  at 
all  hard,  its  passage  is  often  followed  by  pain,  lasting  for  some  time, 
generally  of  a  burning  character.  Frequently,  however,  no  pain  is 
experienced,  and  the  presence  of  blood  is  the  sole  indication  of  the 
existence  of  piles.  Sometimes,  when  an  internal  pile  is  large,  or  when 
it  is  situated  immediately  within  the  opening  of  the  bowel,  it  will  come 
down  into  the  opening  after  the  bowels  have  acted,  and  being  squeezed 
in  the  opening  will  give  rise  to  much  pain,  which  can  usually  be 
relieved  at  once  by  pressing  the  pile  with  the  finger  upwards  into  the 
interior  of  the  bowel.  [Pelvic  Pine  Cones  (see  page  1228)  exert  a  most 
soothing,  tonic,  and  comforting  effect  on  internal  piles,  goingas  they  do, 
“right  to  the  spot.”  They  contain  the  soothing  properties  of  Magnetic 
Ointment,  and  the  mild  astringency  of  the  pine.] 

External  piles  appear  as  small  swellings,  varying  in  size  from  a 
pea  to  a  marble,  round  the  margin  of  the  opening  of  the  bowel,  and 
occasionally  partly  within  it.  When  not  inflamed,  they  are  of  the  color 
of  natural  skin,  or  of  a  bluish  tinge  similar  to  that  of  a  vein  seen 
through  the  skin  ;  they  are  apt  to  vary  a  little  from  day  to  day  both  in 
color  and  in  size.  When  large,  they  cause  some  discomfort  in  sitting, 
and  sometimes  also  when  walking,  and  are  often  very  painful  for  some 
time  after  an  action  of  the  bowel.  External  piles  do  not  bleed.  Occa¬ 
sionally  they  become  inflamed,  and  are  then  acutely  painful.  When 
attacked  by  inflammation,  they  may  increase  in  size  so  much  as  to  attain 
the  dimensions  of  a  hen’s  egg.  Their  color  becomes  changed  to  a 
dusky  red,  and  the  reddened  skin  becomes  so  tense  as  to  appear  partly 
translucent ;  not  infrequently  it  gives  way  here  and  there,  and  smali 
superficial  ulcers  covered  with  a  little  matter  appear  on  the  surface.  It 
is  very  seldom,  however,  that  the  inflammation  progresses  so  far  as  to 
form  an  abscess  ;  after  a  few  days  rest  and  care  it  usually  subsides. 

The  occurrence  of  piles  may  be  often  prevented  by  proper  attention 
to  regularity  in  the  action  of  the  bowels,  by  due  support  of  the  abdo¬ 
men,  and  by  warm  clothing.  When  they  do  occur,  either  internally  or 
externally,  the  same  precautions  will,  in  the  majority  ot  cases,  obviate 
much  of  the  discomfort  to  which  they  sometimes  give  rise.  TV  hen  in¬ 
ternal  piles  bleed  much  and  often,  it  is  very  desirable  to  obtain  medical 
-assistance,  as  a  daily  loss  of  even  a  small  quantity  of  blood  is  quitw 

sufficient  to  impair  considerably  the  general  health. 

2m 


42 


DISORDERS  OF  PREGNANCY. 


If  an  interna]  pile  descend  after  the  bowels  have  been  moved,  and 
remain  painfully  grasped  by  the  opening  of  the  bowel,  it  should  be 
carefully  pressed  upwards  with  the  finger,  coated  with  a  little  vaseline 
or  sweet  oil,  until  it  recedes  completely  within  the  opening.  [Nothing 
does  so  well  for  this  purpose  as  the  Magnetic  Ointment,  which  not  only 
helps  to  relieve  at  once,  but  also  exerts  a  curative  influence  when 
applied  daily — or  as  often  as  required  to  return  the  prolapsed  pile. 
See  page  1228.] 

External  piles  are  often  much  reduced  in  size,  and  rendered  less 
sensitive,  by  sponging  them  with  cold  water  morning  and  evening.  In 
some  cases  sponging  with  water  as  hot  as  it  can  be  borne  gives 
greater  relief.  Standing  much  on  the  feet  is  apt  to  increase  their  size  ; 
and  the  recumbent  posture  for  an  hour  or  two  daily  will  often  do  much 
to  render  external  piles  innocuous.  When  they  become  inflamed,  rest 
in  a  recumbent  position  is  absolutely  necessary  ;  and  great  comfort  is 
derived  from  frequent  warm  fomentations,  and  from  the  application  of 
linseed  poultices.  When  piles  are  inflamed,  it  is  generally  desirable  to 
abstain  entirely  from  all  alcoholic  fluids.  Much  attention  should  be 
given  to  the  regular  daily  action  of  the  bowels  ;  and  if  necessary  some 
licorice  powder  should  be  taken  every  night,  or  sulphur  lozenges  every 
morning,  [or  one  or  two  Anti-bilious  Pills.] 

Vaginal  Discharge  and  Irritation. — During  pregnancy  there  is 
not  unfrequently  more  or  less  discharge  from  the  vagina,  sometimes  of 
a  watery  character,  at  other  times  of  a  more  thick  and  creamy  appear¬ 
ance.  It  seldom  exists  to  such  an  extent  as  to  render  it  necessary  to 
wear  a  diaper  ;  but  not  unfrequently  the  discharge  is  rather  irritating, 
and  causes  itching  and  some  degree  of  soreness  externally.  This  itch¬ 
ing  and  soreness  are  usually  much  alleviated  by  bathing  the  parts  once 
or  twice  a  day  with  warm  water  alone,  or  with  warm  water  in  which 
some  bicarbonate  of  soda,  or  some  borate  of  soda  has  been  dissolved. 
A  convenient  strength  of  lotion  is  made  by  dissolving  a  full  teaspoonful 
ot‘  either  of  these  salts  in  a  pint  of  warm  water.  If  such  a  lotion  is  not 
sufficient  to  allay  the  itching,  the  application  of  some  carbolized  vase¬ 
line  two  or  three  times  daily  may  be  tried.  When  the  discharge  is 
excessive  in  quantity,  or  very  irritating  in  character,  it  may  be  neces¬ 
sary  to  syringe  the  interior  of  the  vagina  once  or  twice  daily  with  warm 
water,  or  with  such  a  lotion  as  is  given  above.  For  this  purpose  a 
family  syringe,  such  as  has  been  described  on  page  33,  for  administer¬ 
ing  enemas,  is  employed,  the  longer  terminal  tube  being  placed  over 
the  proper  end.  This  gum-elastic  tube  being  covered 'with  vaseline, 
after  the  syringe  has  been  charged  with  the  warm  water  or  lotion,  and 
the  weighted  end  left  immersed  in  it,  is  introduced  gently  into  the 
vagina  for  two  or  three  inches,  and  the  lotion  injected  by  successive 
gentle  compressions  of  the  ball  of  the  syringe.  The  lotion,  after  com- 


/ 


SLEEPLESSNESS.  43 

ing  in  contact  with  the  interior  of  the  vagina,  escapes  at  the  sides  of 
the  gum-elastic  tube. 

Women  who  can  bear  cold  bathing  well  will  often  find  that  a  cold 
bath,  and  where  possible  a  sea-wrater  bath,  taken  regularly  every  morn¬ 
ing,  is  very  efficacious  in  curing  both  the  excessive  discharge  and  the 
consequent  irritation.  It  may  be  remarked  here  that  to  those  who  in 
ordinary  health  enjoy  sea-bathing,  there  is  no  risk  from  open-air  batli 
ing  during  pregnancy;  and  often  the  influence  of  sea-bathing  under 
these  circumstances  is  distinctly  beneficial  to  the  general  health. 

Sleeplessness  is  occasionally  the  source  of  considerable  discom¬ 
fort  in  both  the  earlier  and  the  later  months  of  pregnancy.  In  the 
earlier  stages,  it  is  usually  due  more  directly  to  discomforts  of  digestion 
or  to  attacks  of  palpitation  ;  wdiile,  later,  the  disturbing  movements  of 
the  child,  aud  difficulties  of  position  owing  to  increase  of  size,  interfere 
occasionally  with  sound  slumber.  Any  treatment  must  be  directed  to 
the  cause  upon  which  the  sleeplessness  is  dependent.  Care  in  diet,  and 
regulation  of  the  action  of  the  bowels,  will  assist  much  in  sleeplessness 
due  to  indigestion. 

When  the  movements  of  the  child  are  troublesome,  the  wearing  of 
a  belt  or  binder  at  night,  as  well  as  during  the  day,  will  often  render 
them  more  tolerable,  and  apparently  sometimes  even  less  violent.  The 
binder  is  also  useful  where  the  enlargement  of  the  figure  makes  the 
attainment  of  a  comfortable  position  difficult ;  and  some  assistance 
toward  this  can  also  be  obtained  by  the  disposal  of  small  cushions  or 
pillows  in  such  a  way  as  to  give  support  where  it  may  be  required. 

Narcotic  drugs  for  producing  sleep  should  never  be  taken  except 
under  medical  advice.  In  many  ways  they  may  do  injury,  not  only  to 
the  mother,  but  also  to  the  infant,  and  their  use  is  justifiable  only 
under  conditions  laid  down  by  a  qualified  doctor. 


i 


CHAPTER  V. 


Miscarriage,  its  Causes,  Risks,  Pretention,  and  Management. 

Definition  of  Miscarriage;  Usual  Periods  of  Occurrence;  Earlier  Miscarriages; 
Difficulty  of  Recognition;  Necessity  of  Care  after  their  Occurrence;  Cause 
of  Miscarriage;  Indications  of  Threatened  Miscarriage;  Discharge  of 
Blood;  Pain;  Preventive  Treatment ;  Rest;  Coolness;  Light  Diet;  Indica¬ 
tions  for  Medical  Aid;  Necessity  of  Patience;  Symptoms  of  Inevitable  Mis¬ 
carriage  ;  Description  of  Abortion ;  Indications  of  Complete  Removal ;  Re¬ 
sults  of  Incomplete  Removal;  Convalescence  from  Miscarriage;  Necessity 
of  Rest;  Value  of  Syringing;  Preparation  of  Lotions;  Diet  during  Conva¬ 
lescence;  Occasional  Discomfort  of  Breasts;  Final  Remarks. 

The  term  miscarriage  or  abortion  is  usually  applied  to  the  pre¬ 
mature  birth  of  the  infant  at  any  time  during  the  first  six  months  of 
pregnancy.  After  the  first  six  months,  if  confinement  takes  place 
before  the  usual  period  of  nine  months  has  elapsed,  it  is  generally 
called  premature  confinement.  Although  miscarriage  may  occur  at  any 
period  within  six  months  after  the  commencement  of  pregnancy,  it 
most  commonly  takes  place  either  about  one  month  after  the  time  of 
conception,  or  between  two  and  a  half  and  four  months  after  that  date. 

The  earlier  miscarriages,  after  about  one  month’s  pregnancy,  are 
not  generally  regarded  as  of  much  importance,  and  in  many  cases  their 
character  is  not  recognized,  the  accompanying  discharge  of  blood  being 
mistaken  for  an  ordinary  monthly  period,  postponed  a  little  in  date  and 
slightly  increased  in  amount.  Very  frequently  it  happens  in  married 
women  that  the  usual  monthly  period  is  one  or  two  wreeks  late,  and  is 
accompanied  by  some  amount  of  pain,  and  more  or  less  increased  flow 
of  blood  ;  and  it  will  often  be  noticed  that  in  such  a  case  the  flow  lasts 
somewhat  longer  than  usual,  and  may  be  followed  for  some  days  or 
even  longer  by  a  colorless  or  yellow  discharge.  The  explanation  of 
these  exceptional  conditions  is  usually  the  occurrence  of  an  early  mis¬ 
carriage  ;  and  while  in  most  instances  no  ill  effects  are  left  behind,  it 
is  not  very  uncommon  to  find  some  uterine  discomfort,  in  the  form 
perhaps  of  continuous  slight  discharge  from  the  vagina  or  aching  of 
the  back  after  much  exertion,  owing  its  origin  to  a  miscarriage  of  the 
kind  described.  If  any  of  the  symptoms  of  pregnancy  have  been  ob¬ 
served  prior  to  the  postponed  discharge,  little  doubt  can  exist  as  to  its 

nature  ;  and,  when  such  indication  exists,  it  is  always  judicious  to  try 

44 


CAUSES  OF  MISCARRIAGE. 


45 


to  avert  any  evil  consequences  by  resting  quietly  for  two  or  three  days, 
avoiding  all  fatigue  and  exposure  to  cold,  and  spending  at  least  part  of 
the  day  recumbent  on  a  couch.  It  should  always  be  borne  in  mind  that 
miscarriage  at  any  period,  early  or  late,  of  pregnancy,  is  an  abnormal 
process  which  necessarily  involves  some  degree  of  injury  to  the  womb  ; 
and  it  is  a  fact  well  recognized  by  the  medical  profession  that  to 
neglected  miscarriages  are  attributable  a  great  number  of  the  more 
common  diseases  of  the  womb  so  frequently  met  with  in  practice. 


Pig.  6 


FOETUS  OF  THREE  TO  FOUR  WEEKS— NATURAL  SIZE— AS  CONTAINED  IN  1T.» 

MEMBRANES  IN  THE  WOMB. 

The  importance,  therefore,  of  care  and  circumspection  during  such  an 
occurrence  ought  to  be  fully  recognized  by  every  married  woman. 

Causes  of  Hiscarriage.— For  the  early  miscarriages  just  de¬ 
scribed,  it  is  not  easy  to  point  to  any  cause  beyond  mentioning  t  he  gen 
eral  fact  that  throughout  pregnancy  there  seems  always  to  be  some 
slight  tendency  to  miscarriage  at  such  dates  as  would  conesponc  to 
the  monthly  periods,  which  are  usually  suppressed  during  pregnancy  ; 
and  this  tendency  is  probably  stronger  about  the  time  of  the  lust 

monthly  interval  after  pregnancy  has  commenced. 

The  causes  of  later  miscarriages  may  be  found  in  circumstances 
connected  either  with  the  mother  or  with  the  child.  There  seems  no 
doubt  that  some  women  have  an  innate  tendency  to  miscarry,  even 


46 


MISCARRIAGE  OR  ABORTION. 


when  apparently  in  perfect  health,  the  explanation  probably  lying  in 
some  irritability  of  the  nervous  system.  There  is  also  a  tendency  to  a 
repetition  of  miscarriages  at  about  the  same  period  of  pregnancy,  even 
in  cases  where  the  first  miscarriage  may  have  been  due  to  accidental 
causes. 

Any  illness  which  has  enfeebled  temporarily  or  permanently  the 
constitution  will  predispose  to  miscarriage  ;  and  mental  anxiety  and 
worry  probably  act  in  a  similar  manner.  Acute  diseases  accompanied 
by  fever  have  a  very  adverse  effect  on  pregnancy,  and  high  fever  from 
any  cause  always  endangers  its  continuance. 


Fig.  7. 


A  SIX  WEEKS  OLD  FCETUS  IN  ITS  SAC,  WITH  THE  MEMBRANES  BY  WHICH  IT  IS 

ATTACHED  TO  TIIE  WOMB. 

Imprudent  conduct ,  such  as  over-fatigue  in  walking,  or  riding,  or 
dancing,  has  a  tendency  to  induce  miscarriage,  and  there  is  especial 
risk  in  exercise  involving  sudden  shocks,  such  as  jumping  on  horseback. 
Sadden  mental  shocks,  especially  those  of  a  startling  or  alarming  char¬ 
acter,  account  for  a  considerable  number  of  miscarriages.  The  most 
important  cause  of  all  referable  to  the  mother  is  probably  the  existence 
of  slight  disease  of  the  womb,  or  of  tissues  in  the  neighborhood  of  the 
womb.  Some  diseases  of  this  organ  in  their  slighter  forms  produce 
comparatively  little  discomfort,  and  partly  from  this  reason,  and  partly 
from  motives  of  delicacy,  are  not  ^infrequently  entirely  neglected  ;  and 
the  penalty  of  the  neglect  is  incurred  in  the  form  of  successive  miscar¬ 
riages,  which  in  their  turn  eventually  aggravate  the  previously  existing 
disease  to  which  they  are  to  be  attributed.  [When  the  “abortion 


SYMPTOMS  OF  MISCARRIAGE. 


47 


habit  ”  has  become  established  as  a  state  of  disease,  or  when  the  womb 
has  become  too  tender  and  “touchy”  to  carry  on  the  process  of  child¬ 
bearing  to  “full  term” — as  it  often  does,  because  of  chronic  disease — it 
is  fortunately  generally  possible  to  restore  the  parts  to  normal  condition 
by  suitable  local  and  constitutional  treatment.  The  “abortion  habit” 
is  risky  and  exhausting,  and  should  be  overcome  for  the  sake  of  the 
woman’s  health,  if  for  nothing  else.  See  page  1226.] 

Miscarriages,  again,  are  not  unfrequently  due  to  some  disease 
affecting  the  infant  in  the  womb.  There  is  no  doubt  that  from  the  very 


Fig.  8. 


EMBRYO  OR  ECETUS  OF  EIGHT  WEEKS  IN  ITS  SAC,  ANIJ  ATTACHMENTS;  ALL  OF 

WHICH  COME  AWAY  IN  A  MISCARRIAGE. 

beginning  of  pregnancy,  the  infant  itself  is  liable  to  disease,  indepen¬ 
dently  altogether  of  the  state  of  health  of  the  mother.  These  diseases 
frequently  terminate  in  the  death  of  the  child  within  the  womb,  and 
miscarriage  usually  ensues  very  soon  afterwards. 

Indications  of  Threatening  Miscarriage.— In  most  cases  of 
threatened  miscarriage,  the  first  symptom  which  attracts  attention  is 
the  discharge  of  blood  from  the  vagina.  Very  frequently,  prior  to  this 
occurrence,  some  indefinite  sensation  of  discomfort  may  h.i\e  been  ex 
perienced.  Sometimes  the  commencement  is  indicated  by  sensations  of 
cold,  and  even  shivering,  followed  by  slight  fever  ;  in  other  cases,  sen¬ 
sations  of  weight  at  the  bottom  of  the  abdomen,  a  feeling  of  cold  there, 
and  perhaps  slight  occasional  attacks  of  pain  low  down  in  the  back  or 


MISCARRIAGE  OR  ABORTION. 


48 

abdomen,  may  have  awakened  suspicions  of  possible  risk.  Occasion¬ 
ally,  a  considerable  amount  of  pain  in  the  lower  part  of  the  abdomen  is 
felt  before  any  discharge  is  observed.  The  pain  is  usually  of  a  very 

Fig.  9. 


FCETUS  AT  FOUR  MONTHS,  EXPOSED  IN  ITS  MEMBRANES,  SHOWING  CORD. 

characteristic  description,  resembling  somewhat  that  of  colic,  and  being 
regularly  intermittent,  the  intermissions,  as  a  rule,  lasting  longer  than 
the  paroxysms  of  pain.  The  regularity  and  the  situation  of  the  recur¬ 
rent  spasms  generally  are  sufficient  to  distinguish  them  from  those 
due  to  colic  of  the  bowel.  Even  in  those  exceptional  instances  where 
pain  is  the  earliest  prominent  symptom,  the  discharge  of  blood  soon 
follows  ;  and  the  combination  of  the  two  indicate  conclusively  the  im¬ 
minent  risk  of  miscarriage. 


PREVENTION  OF  MISCARRIAGE. 


49 


The  amount  of  discharge  varies  very  much  in  different  cases,  and 
at  different  stages.  At  first  it  is  generally  slight,  and  may  resemble 
very  much  that  of  an  ordinary  monthly  period  ;  but  it  generally 
increases  to  a  degree  much  beyond  this  if  the  miscarriage  progresses. 

After  the  discharge  has  existed  for  some  variable  time,  an  amount 
of  pain  is  usually  felt  in  the  lower  part  of  the  abdomen,  beginning  in 
slight  rhythmical  spasms  at  intervals  of  some  minutes,  and  becoming 
gradually  more  severe,  with  shorter  intervals  between  the  spasms.  As 
the  pain  increases,  the  amount  of  discharge  usually  increases  also,  and 
in  a  few  cases  becomes  so  much  as  to  excite  considerable  alarm. 

Preventive  Treatment. — Since  it  is  almost  always  impossible  to 
know  whether  the  threatened  miscarriage  is  due  to  the  death  of  the 
infant  in  the  womb,  or  to  some  condition  relating  to  the  mother  which 
may  be  remedied,  it  is  judicious  and  right  always  to  presume  that  the 
infant  is  alive,  until  distinct  evidence  of  its  death  is  obtained,  and 
accordingly  to  take  what  measures  are  calculated  to  prevent  the  prog¬ 
ress  of  the  miscarriage,  and  insure  the  safe  progress  of  the  pregnancy  ; 
and  it  is  encouraging  that  in  many  cases,  even  where  the  discharge  has 
been  considerable  and  the  pain  troublesome,  judicious  means  are  suc¬ 
cessful  in  arresting  the  unhealthy  action  of  the  womb,  and  saving  the 
life  of  the  threatened  infant. 

With  this  end  in  view,  it  is  the  imperative  duty  of  every  woman 
who  has  the  prospect  of  becoming  a  mother,  when  the  first  symptoms 
of  threatened  miscarriage  appear,  to  remain  completely  at  rest  in  the 
recumbent  position.  If  there  is  no  symptom  except  the  colored  dis¬ 
charge,  and  if  this  is  not  excessive  in  amount,  judged  comparatively 
with  the  usual  monthly  period,  it  may  not  be  considered  necessary  to 
summon  medical  assistance  ;  but  the  maintenance  of  rest  in  a  horizontal 
position  is  of  essential  importance.  The  atmosphere  of  the  room  should 
not  be  too  warm,  and  excessive  warmth  of  clothing  or  bed-clothes 
should  be  avoided.  Diet  should  be  light  and  easy  of  digestion,  prefer¬ 
ence  being  given  to  milk-food  and  fish  ;  and  the  food  taken  should  not 
be  very  warm,  as  heat  of  any  kind  is  apt  to  increase  the  amount  of  dis¬ 
charge,  and  the  consequent  risk  of  miscarriage.  There  is  no  objection 
to  thickened  soups  or  to  tea,  'if  taken  when  slightly  cooled.  When 
miscarriage  is  threatened,  purgative  medicines  which  are  at  all  likely 
to  act  violently  should  be  carefully  avoided.  It  is  not,  however,  well 
to  allow  the  bowels  to  become  too  confined  ;  and  when  necessary,  a 
little  castor-oil  or  licorice  powder  may  be  taken,  or  the  bowels  may  be 
acted  on  by  an  injection  of  glycerine. 

If  the  discharge  becomes  excessive  in  amount,  or  if  pain  to  any 
great  extent  supervenes,  it  is  very  desirable  that  medical  assistance 
should  be  obtained  as  early  as  possible. 


50 


MISCARRIAGE  OR  ABORTION. 


To  most  women  the  management  of  their  health  when  a  miscar¬ 
riage  is  threatening  will  be  found  rather  a  trial  of  patience.  Not  per* 
liaps  always  realizing  the  importance  of  the  matter,  and  the  necessity 
of  what  may  appear  severity  of  restriction,  the  maintenance  of  rest  and 
the  restraint  of  diet  to  many  are  apt  to  appear  unnecessarily  irksome. 
A  comparatively  slight  discharge,  unaccompanied  by  pain,  will  occa¬ 
sionally  persist  for  some  weeks ;  and  it  will  generally  be  found  to 
increase  when  movement  is  made,  or  when  the  erect  position  is  assumed. 
To  a  woman  accustomed  during  her  ordinary  monthly  period  to  lead 
her  usual  life,  this  may  seem  a  very  poor  reason  indeed  for  giving  up 
entirely  her  ordinary  avocations,  and  adopting  for  a  time  the  role  of  an 
invalid.  But  the  importance  of  the  object  sought  will  be  more  fully 
recognized  when  one  realizes  that  a  human  life  is  at  stake — a  young 
life,  it  is  true,  but  one  which,  if  preserved  by  a  few  weeks’  care  and 
self-sacrifice  on  the  part  of  the  mother,  may  attain  to  many  years  of 
future  usefulness.  There  are  very  few  conditions  in  which  the  full 
confidence  of  a  patient  in  her  medical  attendant  is  more  demanded  than 
when  she  is  under  treatment  for  threatened  miscarriage.  Patients,  as 
a  rule,  are  very  desirous  that  their  medical  attendant  should  at  least 
“do  something ; ”  while  in  many  cases  of  the  kind  under  description, 
much  the  best  method  of  conducting  the  pregnancy  to  a  satisfactory  con¬ 
clusion  is  to  do  nothing,  beyond  exercising  a  careful  and  judicious  obser¬ 
vation.  True  it  is  that  medical  science  is  in  possession  of  drugs  which 
serve  to  allay  pain  when  severe,  and  to  restrain  excessive  uterine  action  ; 
but  in  a  considerable  number  of  cases  the  employment  of  such  drugs  is 
not  required.  The  symptom  which  most  usually  calls  for  medical 
treatment  is  the  existence  of  excessive  discharge.  When  rest,  coolness, 
and  abstinence  have  been  insufficient  to  keep  the  discharge  within  such 
limits  as  will  not  seriously  impair  the  strength  of  the  patient,  there  are 
other  resources  within  the  means  of  a  medical  man,  which  can  always 
be  relied  on  to  arrest  the  bleeding.  These  means,  however,  rather  tend 
to  provoke  than  to  restrain  the  tendency  to  miscarriage,  and  are  there¬ 
fore  not  generally  employed  until  the  necessity  of  arresting  the  dis¬ 
charge  becomes  quite  apparent. 

If  the  means  described  above  are  not  sufficient  to  arrest  the  prog¬ 
ress  of  the  miscarriage,  it  will  be  found  that  the  intermittent  parox¬ 
ysms  of  pain  continue  with  greater  frequency  and  severity,  while  the 
discharge  will  persist.  As  a  rule,  the  discharge  is  not  characterized  by 
any  odor ;  and  if  in  the  absence  of  any  local  treatment  to  arrest  the 
bleeding  a  distinctly  disagreeable  or  fetid  smell  is  perceived,  a  fairly 
reliable  indication  is  given  that  the  infant  is  dead,  and  that  therefore 
further  efforts  to  prevent  miscarriage  are  superfluous.  The  object 
thereafter  aimed  at  is  to  conduct  the  miscarriage  to  its  termination  with 
as  little  delay  as  possible.  But  here  also  may  often  be  found  the  value 


PREVENTION  OF  MISCARRIAGE. 


51 


of  the  advice  of  the  Latin  motto,  Festina  lente — “Speed  gently.”  One 
of  the  difficulties  connected  with  miscarriage  is  the  tendency  of  the 
womb  at  this  stage  to  expel  part  of  its  contents  and  retain  another 
part,  instead  of  ejecting  the  whole  at  one  time.  At  about  the  end  of 
the  third  month  of  pregnancy  the  contents  of  the  womb  may  be  thus 
described.  The  interior  cavity  of  the  womb  at  this  period  varies  from 
about  the  size  of  a  cricket-ball  to  that  of  a  croquet-ball  or  cocoanut. 
This  is  almost  completely  occupied  by  a  membranous  bag  filled  with  a 
watery  fluid,  in  which  floats  the  young  infant,  at  this  period  from  four 
to  five  inches  in  length.  From  the  navel  of  the  infant  a  thin  cord  pro¬ 
ceeds  to  one  point  in  the  interior  of  the  bag,  and  this  cord  is  the  only 
connection  between  the  infant  and  the  mother,  excepting,  of  course, 
the  wratery  fluid  with  which  it  is  surrounded.  Coming  from  the  navel 
of  the  child,  it  passes  through  the  bag,  and  is  spread  out  in  a  sort  of 
cushion  attached  to  the  inside  of  the  womb,  which  is  known  as  the 
“placenta.”  The  bag  of  membranes  and  the  placenta  together  entirely 
fill  the  cavity  of  the  womb.  The  placenta  is  fleshy  in  appearance, 
round  or  oval  in  shape,  and  about  half  an  inch  to  an  inch  thick  in  the 
centre,  becoming  thinner  at  the  edges.  One  side  of  it  is  closely  attached 
to  the  outside  of  the  bag  of  membranes,  the  other  is  adherent  to  the 
internal  wall  of  the  womb. 

During  the  progress  of  a  miscarriage  which  has  become  inevitable, 
the  bag  of  membranes  usually  bursts,  and  the  contained  watery  fluid 
escapes  along  with  the  discharge  of  blood.  In  many  cases  the  enclosed 
infant  comes  away  soon  afterwards,  and  is  found  outside  the  vagina, 
attached  only  by  the  cord  to  the  placenta,  which  is  still  adherent  to  the 
womb.  The  cord  varies  very  much  in  length,  and  in  many  cases  is 
quite  long  enough  to  allow  the  child  to  escape  entirely  from  the  vagina, 
while  still  attached  to  the  placenta ;  but  if  it  is  not  long  enough  for 
this,  it  usually  breaks,  and  the  attachment  to  the  placenta  is  thus  lost. 

In  those  cases  where  the  infant  is  expelled  before  the  placenta  has 
become  separated  from  the  wall  of  the  womb,  it  not  unfrequently  hap¬ 
pens  that  the  womb  ceases  for  a  time  its  efEort  to  expel  the  whole  of  its 
contents,  and,  closing  up  to  some  extent  after  the  expulsion  of  the 
infant,  encloses  within  its  cavity  the  adherent  placenta  and  attached 
membranes.  The  enclosed  placenta  then  begins  to  decompose,  and 
keeps  up  a  fetid  discharge,  accompanied  sometimes  by  considerable 
bleeding,  which  is  not  only  very  disagreeable  and  annoying,  but  also 
injurious  to  the  general  health. 

I11  guiding  a  miscarriage  to  a  satisfactory  conclusion,  the  main 
object  of  the  medical  man  is  to  secure,  as  far  as  possible,  that  the  cav¬ 
ity  of  the  womb  shall  be  entirely  emptied  of  all  its  contents,  including 
the  infant,  the  placenta,  and  the  membranous  walls  of  the  bag.  It  is 
found  generally  that  the  most,  satisfactory  method  of  accomplishing 


52 


MISCARRIAGE  OR  ABORTION. 


this  is  to  abstain  as  far  as  possible  from  hurrying  the  process  of  miscar¬ 
riage.  For  a  satisfactory  termination  to  a  miscarriage,  two  conditions 
at  least  are  necessary  :  one  that  the  mouth  or  entrance  of  the  womb  at 
the  upper  end  of  the  vagina  should  be  sufficiently  open  to  allow  the 
infant  and  placenta  to  come  out ;  the  other,  that  the  connection  be¬ 
tween  the  placenta  and  the  interior  wall  of  the  womb  should  be  severed 
completely,  or  at  least  to  a  considerable  extent,  before  the  infant  is 
expelled.  Both  these  conditions  are  effected  slowly  by  the  successive 
contractions  of  the  womb,  which  are  the  cause  of  the  rhythmical  parox¬ 
ysms  of  pain  ;  and  if  the  process  of  miscarriage  is  too  rapid  or  hurried, 
difficulties  are  very  apt  to  arise  from  the  continued  adherence  of  the 
placenta  to  the  womb.  As  the  cause  of  the  bleeding  during  a  miscar¬ 
riage  is  the  separation  of  the  placenta  from  the  wall  of  the  womb,  it 
will  be  easily  understood  how  the  retention  of  the  placenta  is  usually 
accompanied  by  bleeding  as  well  as  by  fetid  discharge.  When  the 
placenta  is  thus  retained,  medical  aid  and  observation  are  urgently 
required  ;  and  no  patient  can  be  considered  convalescent  until  it  has 
come  away  by  itself  or  been  removed  by  the  skill  of  the  doctor. 

When  a  miscarriage  is  of  the  normal  character,  no  one  will  have 
difficulty  in  recognizing  the  separate  contents  of  the  womb,  which  have 
been  described  above — the  infant  or  foetus,  as  it  is  usually  called,  the 
placenta,  and  the  membranes.  It  happens,  however,  not  unfrequently 
that  the  appearance  of  the  contents  is  modified  in  various  ways.  Some¬ 
times  the  bag  of  membranes  bursts  on  the  first  appearance  of  bleeding, 
and  the  blood  may  be  poured  into  the  bag  of  membranes,  displacing 
the  watery  fluid.  When  this  occurs,  the  infant  is  destroyed  by  the  sur¬ 
rounding  blood  ;  and  the  membranes  enclosing  the  blood,  along  with 
the  placenta  external  to  them,  may  come  away  with  the  appearance  of 
a  large  clot  of  blood.  Occasionally  the  placenta  is  attacked  by  disease, 
and  as  the  infant  depends  for  its  nutrition  through  the  cord  on  a 
healthy  condition  of  the  placenta,  the  disease  of  the  placenta  is  fol 
lowed  by  the  death  of  the  infant,  and  the  resulting  miscarriage  has  a 
quite  abnormal  appearance.  And,  again,  in  cases  where  the  infant  has 
died  from  some  disease,  miscarriage  may  not  take  place  at  once,  and 
the  placenta  and  dead  infant  become  much  altered  in  appearance  dur¬ 
ing  their  retention  in  the  womb. 

In  consideration  of  these  facts,  it  is  always  very  desirable  that  any 
solid  body  coming  from  the  womb  should  be  kept  for  the  inspection  of 
the  medical  attendant.  Anything  of  the  kind  is  best  kept  for  inspec¬ 
tion  in  a  little  water  ;  and  if  it  is  disagreeably  fetid  some  colorless  dis¬ 
infectant,  such  as  carbolic  acid,  may  be  added  ;  but  no  disinfectant 
which  will  alter  its  color  or  appearance  should  be  employed.  [The 
illustrations  given  in  the  first  part  of  this  chapter  will  aid  almost  any¬ 
one  to  discover,  by  careful  inspection,  whether  a  foetus  has  come  away,] 


CONVALESCENCE  FROM  MISCARRIAGE. 


53 


In  general,  tlie  medical  attendant  will  be  able  to  satisfy  himself  by 
inspection  of  the  miscarriage  and  by  other  means  of  the  completeness 
of  the  removal ;  but  in  some  cases  it  is  quite  impossible  to  be  absolutely 
sure  that  no  small  fragment  of  placenta  has  been  left  behind. 

The  complete  evacuation  of  the  womb  is  usually  followed  immediately 
oy  complete  cessation  of  the  pain  which,  in  most  cases,  has  been  expe¬ 
rienced  during  the  progress  of  the  miscarriage.  Sometimes  slight 
pains  occur  at  intervals  for  twenty-four  or  thirty-six  hours  after  the 
completion  of  the  miscarriage.  This  is  not,  however,  common  ;  and 
when  such  attacks  of  pain  do  occur,  their  intensity  is  slight,  and  their 
subsidence  rapid.  The  continuance  of  pain  for  more  than  forty-eight 
hours  after  the  apparent  removal  of  the  miscarriage  would  indicate  the 
necessity  of  medical  examination,  and  the  probability  of  retention  of 
some  of  the  contents  of  the  womb. 

The  discharge  also  diminishes  rapidly  after  the  contents  of  the  womb 
have  been  completely  removed.  Not  unfrequently,  the  arrest  of  the 
discharge  is  almost  immediate  and  complete  ;  but  more  generally  it  sub 
sides  gradually,  being  of  a  red  color  for  two  or  three  days,  and 
changing  gradually  from  red  to  green,  then  becoming  yellowish,  and 
dually  ceasing.  While  the  discharge  is  disappearing,  it  is  not  unusual 
to  observe  it  occasionally  becoming  rather  more  red-colored  and  profuse 
after  any  undue  exertion  or  excitement ;  and  if  this  alteration  is  only 
temporary,  lasting  perhaps  for  a  few  hours  or  a  day,  it  is  not  of  much 
importance,  except  in  so  far  as  it  indicates  the  desirability  of  continued 
care  and  rest.  If,  however,  it  becomes  again  of  a  very  bright  red  color, 
and  is  excessive  in  quantity,  or  continues  of  this  character  for  more 
than  one  or  two  days,  it  is  probably  indicative  of  incomplete  evacua¬ 
tion,  and  calls  for  medical  attention. 

Convalescence  from  niscarriage. — During  convalescence  noth¬ 
ing  is  so  important  as  rest  in  the  recumbent  position,  maintained  for  at 
least  one  week.  It  has  been  remarked  previously  that  one  of  the  most 
fertile  causes  of  minor  diseases  of  the  womb  is  neglected  miscarriage. 
After  such  an  occurrence,  the  womb  is  left  bruised,  sometimes  slightly 
lacerated,  its  inner  surface  raw  and  sensitive,  and  its  whole  weight 
increased";  and  the  womb  itself,  and  also  the  tissues  in  its  neighbor¬ 
hood,  are  very  prone  at  such  a  time  to  be  affected  with  inflammation, 
which  is  sometimes  of  rather  intractable  character.  While  it  is  incor¬ 
rect  to  say  that  inflammatory  consequences  are  always  due  to  impru¬ 
dence,  there  is  no  doubt  that  in  many  cases  they  can  be  distinctly 
attributed  to  some  want  of  care  ;  and  they  are  always  aggravated,  even 
when  not  caused,  by  injudicious  laxity  after  miscarriage. 

The  duration  of  the  rest  required  varies  considerably  with  the 
character  of  the  miscarriage,  and  the  duration  of  the  pregnancy,  as 
well  as  with  the  general  state  of  health  of  the  mother.  In  most  easel 


54 


MISCARRIAGE  OR  ABORTION. 


of  miscarriage  at  about  the  end  of  the  third  month  of  pregnancy,  the 
patient  may  be  allowed  to  sit  up  in  bed  to  meals  after  three  or  four 
days  have  elapsed  ;  and  may  change  from  bed  to  a  sofa  at  the  end  of  a 
week.  Persistent  aching  of  the  back  on  sitting  up  is  an  indication  that 
caution  must  be  exercised  ;  and  it  is  always  much  better  to  remain 
recumbent  for  a  few  days  longer  than  to  risk  the  straining  of  the  uter¬ 
ine  ligaments,  of  which  the  backache  is  often  a  symptom.. 

When  the  discharge  has  entirely  disappeared,  . and  the  sitting  post¬ 
ure  can  be  maintained  for  one  or  two  hours  without  fatigue  or  aching, 
some  amount  of  walking  may  be  permitted  ;  and  the  normal  manner  of 
living  is  gradually  resumed. 

During  the  convalescence,  great  comfort  is  often  experienced  from 
syringing  the  vagina  twice  daily  with  warm  water,  to  which  some  anti¬ 
septic  fluid  may  be  added.  The  discharge  is  not  unfrequently  fetid  in 
odor,  and  sometimes  rather  irritating  in  character,  and  the  syringing 
removes  the  fetor  and  reduces  the  irritating  quality  of  the  discharge. 
An  ordinary  family  syringe  may  be  used  for  the  purpose,  with  the 
larger  vaginal  pipe  slipped  into  the  delivery  end  ;  and  for  an  antiseptic, 
carbolic  acid  may  be  employed.  A  convenient  antiseptic  lotion  is  made 
by  adding  one  tablespoonful  of  the  last  mentioned,  to  a  pint  of  warm 
water.  [The  “ tablespoonful”  of  carbolic  acid  (for  a  pint  of  water) 
should  be  the  “one  to  forty”  solution  sold  by  druggists,  or  the  diluted 
watery  solution,  and  not  the  pure  acid.  A  soapy  solution  made  with 
No.  33  of  the  Sanitary  Bureau  soap,  affords  a  handy  and  efficient  means 
of  vaginal  cleansing.  See  page  1230.] 

Diet  during  Convalescence. — While  a  somewhat  restricted  diet 
has  been  indicated  as  appropriate  during  any  threatening  of  miscar¬ 
riage,  after  its  completion  a  more  liberal  regimen  is  desirable  and 
proper.  Soups,  fresh  fish,  fowl,  game,  and  mutton,  with  vegetables, 
may  be  taken,  and  there  is  now  no  objection  to  the  food  being  warm. 
Indigestible  articles  of  diet,  such  as  cured  fish,  richly  seasoned  dishes, 
and  pastry,  should  be  avoided. 

Fulness  of  the  Breasts. — In  a  limited  number  of  cases  of  mis¬ 
carriage,  some  degree  of  fulness  of  the  breasts,  with  sensations  of  ten¬ 
sion  and  tenderness,  is  experienced  ;  and  there  may  be  a  slight  flow  of 
milk  from  the  nipples.  If  this  occurs,  it  is  judicious  to  limit  the  diet 
for  a  day  or  two,  and  to  refrain  from  stimulants.  The  local  discom¬ 
fort  of  the  breasts  will  be  relieved  by  gentle  rubbing  with  olive-oil  [or 
better,  Magnetic  Ointment]  and  an  occasional  mild  aperient  of  com¬ 
pound  licorice  powder,  or  some  effervescing  saline,  will  assist  in 
reducing  the  breasts  to  their  normal  condition. 

Cautions. — In  view  of  the  proneness  to  inflammatory  uterine 
affections  after  miscarriage,  it  is  important  that  symptoms  pointing  to 
disease  of  the  womb  should  not  be  treated  with  neglect,  even  although 


PINAL  CAUTIONS  AS  TO  MISCARRIAGE. 


55 


they  may  not  be  very  troublesome.  Aching  of  the  back  after  exertion, 
the  occasional  or  constant  presence  of  vaginal  discharge,  whether 
white,  yellow,  or  watery  in  character,  exceptional  pain,  or  excessive 
discharge  during  the  menstrual  periods,  are  symptoms  which  would 
suggest  the  propriety  of  medical  advice  and  treatment.  [These  condi¬ 
tions  of  local  congestion  and  even  inflammation  can  be  properly  attended 
to  at  home  by  the  aid  of  advice  and  remedies  furnished  according 
to  the  methods  made  known  on  pages  1224,  1225,  and  1226.  To  neglect 
them  is  to  invite  prolonged  suffering  from  local  weakness,  with  a 
chance  of  establishing  the  abortion  habit,  and  this  of  course  means 
barrenness,  which  may  be  incurable,  if  neglected.] 

In  the  event  of  a  succeeding  pregnancy,  it  is  well  to  bear  in  mind 
the  tendency  mentioned  at  the  commencement  of  the  chapter  to  mis¬ 
carry  at  the  period  of  gestation  at  which  in  the  previous  pregnancy 
abortion  occurred,  and  at  that  time  to  be  specially  careful  and  prudent, 
so  as  to  obviate  as  far  as  possible  the  risk  of  a  similar  disaster. 


\  • 


CHAPTER  VI. 


Premature  Confinement. 

Definition;  Causes;  Recognition  of  Cause ;  Cause  of  Premature  Confinement; 
Importance  of  Prevention;  Effects  of  Premature  Birth  on  Child  and  on 
Mother;  Necessity  of  Care  in  Later  Months  of  Pregnancy;  Signs  of  Im¬ 
pending  Confinement;  Recurring  Attacks  of  Pain;  Distinction  from  Colic; 
Precautions  Necessary;  Baby  Incubators. 

Premature  Confinement  is  the  term  generally  employed  to  char¬ 
acterize  child-birth  occurring  after  six  months  of  pregnancy  have 
elapsed,  and  before  the  full  period  of  nine  months’  gestation  has  been 
attained.  It  is  generally  presumed  that  after  pregnancy  has  progressed 
for  six  months  in  a  normal  manner,  the  infant  is  not  unlikely  to  live, 
even  when  born  prematurely  ;  in  technical  language,  the  infant,  after 
six  month’s  gestation,  is  considered  “viable.”  There  is,  however,  no 
rigid  distinction  of  time  of  gestation,  on  one  side  of  which  it  can  be 
strictly  affirmed  that  the  infant  must  be  born  dead  or  die  shortly  after 
birth.  Children  have  undoubtedly  lived  who  have  been  born  as  early 
as  the  end  of  the  fifth  month  of  pregnancy.  On  the  other  hand,  a  con¬ 
siderable  proportion  of  infants  born  in  the  seventh  month  of  preg¬ 
nancy  live  only  for  a  few  hours,  not  apparently  being  strong  enough  to 
undertake  prematurely  the  burden  of  a  separate  existence.  The  dis¬ 
tinction  between  “miscarriage”  and  “premature  confinement,”  and 
between  “non-viability”  and  “viability”  of  the  infant,  is  purely  a  con¬ 
ventional  one  ;  but  it  is  convenient  in  the  opportunity  it  affords  of 
indicating  considerable  differences  of  character  in  the  premature  termi¬ 
nation  of  pregnancy,  according  as  it  occurs  in  the  earlier  or  the  later 
stages  of  gestation. 

The  Causes  of  Premature  Confinement,  like  those  of  miscar¬ 
riage,  may  be  referable  either  to  the  mother  or  to  the  infant.  Weak¬ 
ened  health  in  the  mother  may  result  in  the  premature  birth  of  the 
infant.  The  various  causes  which  have  been  enumerated  in  the  chapter 
on  Miscarriage  may  act  similarly  in  the  later  stages  of  pregnancy. 
Some  women,  for  no  very  apparent  reason,  seem  never  able  to  progress 
beyond  the  seventh  or  eighth  month  of  pregnancy,  and  each  succes¬ 
sive  pregnancy  is  found  to  terminate  prematurely  at  the  same  period  of 
gestation.  Sometimes  excessive  distention  of  the  womb  from  excep- 

56 


.1 


CAUSES  AND  COURSE. 


57 


tional  amount  of  fluid  surrounding  the  infant  seems  to  induce  premature 
confinement ;  and  twin  pregnancies  are  apt  to  terminate  prematurely, 
probably  for  the  same  reason.  Accidental  discharge  of  blood  in  the 
interior  of  the  womb  is  an  occasional  cause. 

Relative  to  the  infant,  the  same  remarks  apply  which  were  made  in 
the  chapter  on  Miscarriage.  In  the  later  period  of  pregnancy,  it  is 
usually  much  more  easy  to  specify  the  cause  of  premature  confinement 
than  in  the  earlier  months.  The  fact  that  the  infant  is  alive  within  the 
womb  can  be  ascertained  by  the  presence  of  movements  and  confirmed  by 
other  signs  ;  and  the  absence  of  such  indications  for  more  than  a  few 
days  would  excite  suspicions  of  its  death.  It  is  not  judicious,  however, 
for  a  pregnant  woman  tp  assume  at  once  from  the  cessation  of  move¬ 
ments  that  the  infant’s  life  is  endangered  or  lost.  It  is  not  uncommon 
to  be  unconscious  of  movements  for  some  days,  probably  because  the 
movements  are  less  violent  than  usual,  although  they  may  not  have 
ceased  altogether.  Even  an  educated  medical  man  will  often  hesitate 
to  decide,  without  repeated  examination,  that  the  life  of  the  infant  is 
irrevocably  lost ;  and  the  only  safe  rule  of  conduct  is  always  to  assume 
that  the  infant  is  alive  until  very  distinct  evidence  of  its  death  is 
obtained. 

The  Course  of  a  Premature  Confinement  resembles  very 
closely  that  of  a  confinement  at  the  normal  period  of  nine  months’  ges¬ 
tation  ;  and  as  it  will  be  described  fully  in  the  chapter  on  Normal 
Confinement,  only  the  earlier  indications  and  the  means  to  be  adopted 
to  arrest,  if  possible,  the  premature  termination  of  the  pregnancy  will 
be  related  here. 

It  is  desirable  to  realize  the  importance  of  using  every  endeavor  to 
prevent  the  premature  expulsion  of  the  child ,  and  to  prolong  the  preg¬ 
nancy  to  its  full  term,  when  there  is  no  sufficient  reason  for  believing 
that  the  infant  has  ceased  to  live.  There  is  always  some  degree  of 
weakness  and  want  of  vitality  observable  in  an  infant  born  before  the 
completion  of  nine  months  of  pregnancy.  In  proportion  to  the  prema¬ 
turity  of  its  birth,  it  is  small  and  thin  ;  its  movements  are  feeble,  and 
its  cry  is  weak  and  moaning,  in  place  of  being  strong  and  lusty.  Its 
breatliing'is  shallow  and  feeble,  and  its  power  of  feeding  itself  by  suc¬ 
tion  somewhat  limited.  Infants  born  prematurely  are  exceedingly 
susceptible  to  cold  ;  their  hands  and  feet  become  livid  if  at  all  exposed, 
and  they  shiver  unless  carefully  protected  by  very  warm  clothing  or 
cotton-wool  wrappings.  It  is  found  that  they  do  not  progress  with  the 
same  rapidity  as  infants  born  at  full  time.  They  do  not  gain  weight  at 
the  same  rate  as  infants  more  fortunate  in  their  birth,  neither  do  they 
develop  in  other  respects  so  satisfactorily.  They  are  late  in  getting 
teeth  and  in  walking ;  and  their  mental  faculties  occasionally  mature 
very  slowlv.  They  are  also  more  prone  to  the  disease  of  rickets,  and 


PREMATURE  CONFINEMENT. 


58 

if  they  have  any  hereditary  tendency  to  scrofula,  it  manifests  itself 
early,  and  frequently  severely.  Very  often  the  whole  of  their  later 
life  is  characterized  by  some  degree  of  delicacy,  which  is  often  found 
associated  with  a  stature  and  physical  development  considerably  below 
the  average. 

While  the  infant  born  prematurely  suffers  thus  on  the  one  hand 
from  its  own  imperfections,  it  not  unfrequently  is  placed  in  a  disad¬ 
vantageous  position  also  by  the  inability  of  the  mother  to  afford  it 
adequate  nourishment.  The  maternal  breasts  have  not  attained  their 
full  maturity,  and  both  the  quantity  and  the  quality  of  the  milk 
secreted  by  them  are  apt  to  be  defective ;  and  these  defects,  super- 
added  to  the  difficulty  which  the  prematurely  born  infant  encounters  in 
sucking  properly,  render  the  early  nutrition  of  such  infants  a  matter 
calling  for  care,  and  not  unfrequently  exciting  anxiety. 

These  considerations  emphasize  the  propriety  of  exercising  due 
care,  and  some  degree,  perhaps,  of  self-denial,  in  the  later  months  of 
pregnancy.  Over- fatigue  should  be  especially  avoided,  while  exercise, 
so  far  as  possible,  should  be  taken  regularly  ;  reasonable  discretion  in 
diet  should  be  exercised,  and  excesses  of  all  kinds  strictly  avoided.  The 
temptation  to  tight  lacing,  in  order  to  conceal  alterations  of  figure, 
must  be  strenuously  resisted,  as  pressure  of  any  kind  is  apt  to  induce 
labor.  A  reasonable  arrangement  of  loose  clothing  will  generally  effect 
this  purpose  quite  satisfactorily,  and  prevent  the  alteration  of  figure 
being  conspicuous  or  noticeable. 

The  slightest  appearance  of  any  discharge  of  blood  from  the  vagina 
calls  imperatively  for  absolute  rest,  and  indicates  the  propriety  of  med¬ 
ical  advice.  Unlike  the  more  early  miscarriages,  premature  confine¬ 
ments  very  seldom  commence  with  any  discharge  of  blood.  The  first 
indication  that  confinement  is  commencing  is  generally  the  presence  of 
recurring  attacks  of  pain  resembling  colic,  and  usually  felt  in  the  abdo¬ 
men  just  where  the  spasms  of  colic  are  generally  situated.  Occasionally 
they  are  referred  more  to  the  back  ;  but  as  a  rule  there  is  nothing  in 
the  character  of  the  pain  to  distinguish  it  from  that  produced  by  colic. 
Some  distinction  between  the  two  is  found  in  the  more  regular  recur¬ 
rence  of  the  spasms  of  pain  in  labor  than  in  colic.  The  spasms  in  colic 
recur  at  irregular  intervals,  and  successive  attacks  are  often  experienced 
at  different  parts  of  the  abdomen  ;  while  the  recurrent  pains  of  labor 
usually  come  in  regular  rhythm,  and  generally  are  felt  in  the  same  part 
of  the  abdomen.  Colic  pains  are  frequently  accompanied  by  some 
diarrhoea,  and  when  that  occurs  it  is  of  some  value  in  indicating  the 
true  character  of  the  spasms.  The  most  marked  point  of  distinction 
is  found  in  the  fact  that,  during  the  spasmodic  pain  of  labor,  the  whole 
of  the  womb  felt  through  the  abdominal  walls  is  found  to  become 
firmer  and  harder ;  and  the  firmness  and  hardness  diminish  and 


BABY  INCUBATORS. 


59 


disappear  as  the  pain  passes  off,  recurring  again  when  the  pain  returns. 
This  increased  firmness  and  hardness  is  easily  detected  by  any  one 
laying  the  palms  of  the  hands  flatly  on  the  walls  of  the  abdomen 
during  the  spasm  of  pain.  When  recurrent  pains  of  this  description 
are  experienced  by  a  pregnant  woman  one  or  two  months  before  the 
full  time  of  pregnancy  has  elapsed,  she  ought  to  remain  at  rest  on  a 
sofa  or  bed,  and  send  for  her  medical  attendant.  If  he  is  able  to 
satisfy  himself  that  the  infant  is  living,  and  that  premature  confinement 
is  threatened,  there  are  various  medicine  within  his  knowledge  which 
are  often  effective  in  removing  the  pain,  and  arresting  the  premature 
action  of  the  womb  ;  and  the  present  care  and  self-denial  of  the  mother 

Fig.  10. 


THE  FUERST  INCUBATOR. 

a,  window;  b,  moist  sponges;  c,  thermometer;  n  d  d,  opening  in  box,  above  and 
below,  for  ventilation;  e,  e,  e,  e,  e,  hot  soapstones  for  heating. 

are  in  due  time  rewarded  by  the  birth  of  a  strong  child  at  the  end  of 

the  full  period  of  healthy  pregnancy. 

[Infants  born  considerably  before  “  full  term  may  often  be  saved 
from  what  used  to  be  considered  “the  inevitable.’  Tn  short,  duiing  the 
past  fifty  years,  and  mainly  since  1890,  a  few  original  minds  among  the 
physicians  in  charge  of  baby  institutions,  have  seen  the  necessity  ol  sup¬ 
plying  sufficient  and  constant  warmth  for  such  infants,  and  a  vaiiety  ot 
baby  incubators  have  been  contrived.  Some  very  elaborate  and  auto¬ 
matic  baby  hatchers  have  been  supplied  for  the  use  of  large  institutions 
where  premature  birth  is  not  uncommon,  so  that  the  mortality  of 
infants  born  a  month  or  two  too  soon  has  been  greatly  reduced  (from 
(>6  to  36  per  cent.).  Even  “six  months  babes  ”  are  not  despaired  of,  and 
if  born  alive  are  given  the  best  possible  opportunity  to  survive  by  the 


6o 


PREMATURE  CONFINEMENT. 


favorable  conditions  of  palatial  infant  incubators  of  richly  endowed 
foundling  asylums.  These  elaborate  contrivances  are  very  expensive, 
and  the  call  for  them  is  so  infrequent  that  they  cannot  be  put  on  the 
list  of  household  necessities,  but  when  the  rather  rare  event  of  prema- 
lure  birth  of  a  living  child  occurs  where  a  ready-made  *‘conveuse” 
(the  French  name)  cannot  be  obtained,  a  life  may  be  saved  by  knowing 
how  to  make  a  baby -hatcher  out  of  an  ordinary  box,  as  proposed  by  Dr. 
L.  Fuerst,  of  Leipzig,  in  1887.  The  illustration  on  page  59  shows  its 
construction  so  well  that  his  lengthy  verbal  description  is  hardly  neces¬ 
sary.  About  a  dozen  heated  soapstones  are  needed  to  raise  the  interior 
temperature  to  the  required  90  degrees,  and  these  can  be  exchanged  or 
renewed  as  necessary.  If  such  a  chest  is  not  made  too  tight  the  air 
will  be  changed  by  entering  at  the  bottom  and  gradually  passing  out  at 
the  top,  vrhile  the  wet  sponges  impart  moisture.  These  too  early  birds 
need  warm  air  to  breathe,  as  well  as  protection  from  loss  of  their  own 
body  heat,  and  many  a  puny  infant  born  at  the  right  time  might  be 
greatly  aided  in  its  growth  and  development  by  the  use  of  such  means  to 
insure  artificial  warmth  while  it  is  too  feeble  to  make  body  warmth  for 
itself.  When,  for  various  reasons,  mothers  are  unable  to  give  their 
babies  the  close  personal  attention  they  need,  such  hatching  boxes 
might  be  a  great  boon,  especially  in  cold  weather,  and  give  them  a 
boost  along  the  first  path  of  a  life  which  many  of  them  find  a  hard 
road  to  travel  all  through. — E.  B.  F.,  Jr.] 


CHAPTER  VII 


Preparations  for  Confinement. 


Selection  of  Doctor  and  Nurse;  Arrangements  Regarding  Fees;  Advantages 
of  Personal  Interview  with  Monthly  Nurse;  Selection  of  Room;  Drainage 
of  House;  Accommodation  of  Nurse;  Furniture  of  Room ;  Bed-Pan;  Bed- 
Bath;  The  Family  Syringe ;  Douche;  Sponges;  Sanitary  Towels;  Binders; 
Antiseptic  Fluids;  Carbolized  Vaseline;  Baby’s  Bath;  Soap;  Baby’s  Dia¬ 
pers;  Bassinette;  Baby’s  Basket;  Its  Contents;  Waterproof  Sheeting; 
Arrangement  of  Bed;  Attention  to  Regular  Action  of  Bowels. 

r 

4 

When  the  existence  of  pregnancy  has  become  apparent,  and  the 
probable  date  of  its  termination  estimated  within  reasonable  limits,  it  is 
desirable  to  make  certain  arrangements  so  that  the  process  of  confine¬ 
ment  may  be  passed  through  in  safety  and  comfort,  and  that  the  result 
may  be  satisfactory  as  regards  both  the  complete  recovery  of  the 
mother  and  the  well-being  of  the  infant.  To  this  end  it  is  usual  to 
engage  beforehand  the  services  of  a  medical  attendant  and  of  a  monthly 
nurse.  Not  unfrequently  in  early  married  life  attendance  during  con¬ 
finement  will  be  the  first  service  the  "wife  requires  of  a  doctor  ;  and,  if 
her  new  home  is  far  removed  from  the  old,  she  will  be  called  upon  to 
exercise  a  choice  as  regards  her  medical  attendant.  To  some  extent  the 
selection  may  be  limited  by  local  conditions,  or  by  her  capacity  to  meet 
the  different  scales  of  fees  charged  by  different  medical  men.  She  will 
find  her  various  friends  not  backward  in  describing  the  merits  and  de¬ 
merits  of  their  own  medical  advisers,  and  may  find  considerable  difficulty 
in  coming  to  a  decision  amidst  a  multitude  of  councillors.  The  best 
principle  to  go  upon  is  to  select  the  medical  man  in  whom  she  feels  she 
can  place  most  confidence.  The  relations  between  patient  and  doctor 
are  close  and  frequently  confidential,  and  the  man  whom  she  can  trust 
as  honest  and  straightforward  is  the  one  whose  attendance  she  will  find 
most  satisfactory.  For  the  ordinary  troubles  of  life  one  does  not 
require  a  medical  man  of  preternatural  cleverness,  whereas  one  does 
want  a  doctor  who  can  be  relied  on  to  do  his  very  utmost  for  his  patient, 
and  who  can  be  trusted  to  act  always  in  an  honest  and  honorable  man¬ 
ner  in  the  various  and  sometimes  intricate  relations  in  which  he  may 
be  placed  toward  his  patient  and  her  friends.  Personal  predilection 

will  decide  whether  the  doctor  should  be  young,  or  old,  or  middle- 

61 


62 


PREPARATIONS  FOR  CONFINEMENT. 


aged  ;  but  it  may  be  remarked  that  it  is  a  mistake  to  suppose  that  all 
young  medical  men  are  rash  and  thoughtless,  or  that  all  old  ones  are 
stupid  and  “behind  the  age.”  Having  provisionally  selected  a  medical 
man,  patients  who  are  not  in  such  a  position  as  to  be  independent  of 
pecuniary  considerations  ought  to  ascertain  from  him  his  scale  of  fees. 
Medical  fees  vary  very  much  in  different  localities,  and  among  different 
doctors  ;  and  it  is  very  much  better  to  understand  correctly  at  the 
commencement  of  the  relationship  of  doctor  and  patient  the  terms  upon 
which  it  is  to  be  conducted.  The  doctor  tacitly  covenants  to  give  the 
best  consideration  and  skill  in  his  power  to  further  the  welfare  and 
interests  of  his  patient,  in  consideration  of  the  patient  paying  him  with 
reasonable  punctuality  the  fees  which  he  is  accustomed  to  receive  for 
such  services  ;  and  the  patient  by  sending  for  him  virtually  agrees  to 
pay  such  fees.  It  is,  therefore,  perfectly  just  and  reasonable  that  she 
should  know  beforehand  what  the  usual  fees  of  her  medical  attendant 
are  ;  and  she  should  have  no  hesitation  in  asking  the  question.  If  the 
doctor’s  scale  of  fees  is  higher  than  she  can  afford,  it  is  wise  and  judi¬ 
cious  to  say  so,  thus  giving  the  doctor  the  option  of  lowering  his  fees, 
or  of  declining  to  attend.  Medical  practices  vary  so  much  in  character 
that  it  is  impossible  to  give  any  very  definite  information  in  the  matter 
of  fees.  The  majority  of  general  practitioners  of  medicine  have  what 
are  called  mixed  practices,  which  means  that  their  patients  vary 
greatly  in  social  position,  and  that  the  scale  of  their  fees  is  proportioned 
to  the  financial  condition  of  the  patient.  A  considerable  number  of 
doctors,  however,  have  what  are  known  as  select  practices,  and  decline 
to  attend  any  patient  who  is  not  in  a  position  to  pay  the  fees  which 
they  make  their  minimum  charge.  Fair-minded  people  will  recognize 
that  a  medical  man  has  just  the  same  right  to  select  his  patients  as  the 
patient  has  to  select  a  doctor,  and  will  not  feel  aggrieved  if  the  condi¬ 
tions  under  which  a  doctor  is  willing  to  give  his  services  are  not  quite 
compatible  with  their  own  financial  resources.  Having  selected  a  med¬ 
ical  man,  and  ascertained  his  usual  scale  of  fees,  it  is  well  to  consult 
him  about  the  date  at  which  confinement  may  be  anticipated  and  to 
ask  him  for  any  advice  he  may  wish  to  give  as  to  any  preparations  for 
that  event. 

The  Nurse. — It  will  generally  be  found  desirable  to  take  the 
recommendation  of  the  doctor  as  to  a  monthly  nurse.  The  comfort  of 
the  patient  during  the  period  occupied  in  recovery  from  confinement 
will  be  materially  increased  by  harmonious  interaction  between  the 
doctor  and  nurse  ;  and  medical  men  naturally  recommend  nurses  whom 
they  know  to  be  both  efficient  in  their  duties  and  pleasant  and  accom¬ 
modating  in  their  manners.  It  is  undoubtedly  to  the  doctor’s  as  well 
as  to  the  patient’s  interest  that  the  nurse  should  be  both  able  and  trust¬ 
worthy,  and  his  capacity  and  opportunity  of  judging  of  a  nurse’s  quali- 


CHOICE  OF  BEDROOM. 


63 


fications  are  naturally  greater  than  those  of  the  patients  who  may  have 
previously  employed  her.  Good  monthly  nurses  usually  expect  to  be 
engaged  some  months  previous  to  the  probable  date  of  confinement ; 
such  nurses,  when  popular,  not  unfrequently  have  engagements  for  six 
or  seven  months  in  advance.  It  is  customary  to  arrange  with  them  a 
fee  which  covers  attendance  during  four  weeks  from  the  date  of 
confinement  ;  and  a  reasonable  degree  of  elasticity  as  regards  the  date 
is  always  understood  as  necessarily  involved  in  such  an  arrangement. 
The  fees  of  monthly  nurses  vary  quite  as  much  as  those  of  medical 
men,  and  should  be  made  a  subject  of  distinct  arrangement.  Generally, 
it  is  understood  that  the  monthly  nurse  will  not  be  summoned  until  the 
commencement  of  the  confinement ;  but  many  women  may  prefer  to 
have  their  monthly  nurse  in  their  house  for  a  week  or  two  before  the 
date  of  expected  confinement,  so  that  she  may  be  on  the  spot  when 
required.  When  an  arrangement  of  this  kind  is  made,  the  nurse  usually 
receives  some  fee  for  the  time  she  is  waiting  in  the  house  previous  to 
the  confinement,  this  fee  being  at  a  somewhat  lower  rate  usually  than 
the  fee  for  the  month  following  the  confinement.  Sometimes  the  patient 
may  prefer  that  the  nurse  should  remain  with  her  more  than  four 
weeks,  and  then  also  it  is  usual  for  the  scale  of  payment  to  the  monthly 
nurse  to  be  somewhat  lower  after  the  expiry  of  the  four  weeks 
following  confinement.  All  such  arrangements  should  be  definitely 
made,  when  possible,  at  a  personal  interview  with  the  nurse  on  engag¬ 
ing  her  ;  and  where  a  personal  interview  is  impossible  or  inconvenient, 
a  distinct  understanding  should  be  arrived  at  by  letter. 

In  all  cases,  when  possible,  the  expectant  mother  should  have  an 
early  interview  writh  the  nurse  who  is  to  attend  her  and  care  for  her 
during  her  confinement.  The  nurse  can  assist  her  much  in  suggestions 
by  which  the  period  may  be  passed  in  comfort  and  happiness  ;  and,  as 
every  nurse  has  her  own  special  methods  of  work  and  her  own  partic¬ 
ular  requirements  and  conveniences,  the  relation  between  patient  and 
nurse  will  be  more  harmonious  if  some  little  attention  is  given  to  these 
peculiarities.  Like  medical  men  and  other  people  in  this  world,  nurses 
vary  in  age,  ability,  and  temperament.  Not  so  many  years  ago,  it  was 
an  article  of  faith  that  no  woman  wTas  capable  of  acting  as  a  monthly 
nurse  unless  she  was  at  least  verging  upon  old  age,  and  had  herself 
been  the  mother  of  children.  Matters  are  now  quite  changed  in  this 
respect,  and  many  of  the  best  monthly  nurses  are  quite  young,  and 
frequently  unmarried. 

Choice  of  Bedroom. — When  the  accommodation  of  the  house 
affords  a  choice  of  bedrooms  to  be  occupied  during  confinement,  it  is 
desirable  to  select  the  largest  available  room  ;  and  one  which  enjoys 
much  sunshine  is  preferable  to  one  with  a  northerly  aspect.  1  he  room 
is  to  be  occupied  for  the  greater  part  of  a  month  by  at  least  three  per- 


PREPARATIONS  FOR  CONFINEMENT. 


64 

sons— the  mother,  the  infant,  and  the  nurse  ;  and  it  is  conducive  both' 
to  the  recovery  of  the  mother  and  the  health  of  the  child  that  the  room 
should  be  both  well  ventilated  and  purified  by  sunshine.  If  the  con¬ 
finement  is  to  take  place  in  summer,  dark  blinds  may  be  desirable  for 
the  purpose  of  coolness  and  of  shade  during  the  hottest  and  brightest 
part  of  the  day.  External  sun-blinds  are  very  useful  for  this  purpose, 
and  are  valuable  also  in  assisting  in  ventilation  while  controlling 
draughts. 

The  cleaning  and  sweeping  of  a  room  is  always  a  trying  operation 
to  an  invalid  confined  to  bed,  and  arrangements  should  be  made  to 
obviate  these  proceedings  as  far  as  possible.  Polished  wooden  floors, 
with  mats  or  strips  of  carpet  which  can  be  easily  removed  and  dusted, 
are  much  preferable  in  bedrooms  to  floors  entirely  covered  with  carpet ; 
and  their  convenience  is  especially  noticeable  in  cases  where  the  bed¬ 
room  is  occupied  all  day  as  well  as  at  night.  In  winter,  the  heating  of 
a  bedroom  occupied  during  the  day  should  be  by  an  open  grate.  Gas 
fires,  which  are  very  convenient  for  occasional  use,  are  ineligible  in  a 
room  constantly  occupied,  as  they  injure  somewhat  the  atmosphere  of 
the  room,  and  do  not  aid  ventilation  so  efficiently  as  an  open  fire. 

It  is  exceedingly  important  that  the  drainage  of  a  house  in  which 
any  one  is  to  be  confined  should  be  in  a  thoroughly  satisfactory  condi¬ 
tion  ;  and  in  all  cases  where  there  is  any  doubt  about  the  efficacy  of 
the  sanitary  arrangements,  a  competent  surveyor  should  be  employed 
to  report  on  it.  In  many  districts  the  services  of  such  a  surveyor  can 
be  obtained  gratuitously  from  the  Local  Sanitary  Authority ;  and 
where  the  Sanitary  Authority  does  not  provide  an  inspector,  a  compe¬ 
tent  surveyor  can  usually  be  obtained  to  report  for  a  comparatively 
small  fee.  No  money  can  be  better  spent,  for  a  sanitary  condition  of 
the  Louse  is  decidedly  the  most  important  element  in  insuring  a  satis¬ 
factory  and  unimpeded  recovery  from  confinement,  while  an  insanitary 
condition  is  often  the  cause  of  months  of  illness  after  confinement. 

For  the  accommodation  of  the  nurse,  it  is  very  convenient,  where 
possible,  to  have  a  small  room  either  opening  off  or  adjacent  to  the  bed¬ 
room  of  the  mother.  The  nurse  has  various  duties  to  perform  to  the 
mother  and  child  which  are  most  conveniently  carried  out  in  a  room 
apart  from  the  bedroom  ;  and  by  the  use  of  a  small  room  for  these  pur¬ 
poses  is  able  to  maintain  the  bedroom  always  in  a  tidy  and  neat  condi¬ 
tion.  Such  a  room  can  also  be  utilized  by  the  nurse  for  her  meals, 
when  they  are  taken  apart  from  her  patient. 

The  bedroom  in  which  confinement  is  to  take  place  should  not  be 
inconveniently  filled  with  furniture.  Furniture  occupies  space  which 
otherwise  is  occupied  by  air  useful  for  ventilating  purposes  ;  and  it  is 
impossible  to  be  too  careful  in  the  thorough  ventilation  of  the  lying-in 
chamber.  Among  the  essential  articles  of  furniture  may  be  mentioned 


REQUISITES  FOR  THE  MOTHER. 


65 


a  double  bed  with  mattresses  which  are  not  too  soft ;  a  comfortable 
night-stool  or  chair  for  use  during  convalescence,  and  a  convenient 
toilet-table  with  drawers  to  hold  necessary  articles.  Some  of  the  arti¬ 
cles  to  be  mentioned  are  requisite  for  the  comfort  and  convenience  of 
the  mother,  while  others  are  devoted  to  the  use  of  the  nurse,  or  the 

wants  of  the  infant. 

/ 


Requisites  for  the  Mother. — Of  the  articles  desirable  for  the 
mother  one  of  the  most  important  is  a  comfortable  bed-pan.  For  some 
days  after  confinement,  the  patient  is  not  usually  allowed  to  leave  bed 
for  any  purpose,  and  the  use  of  a  bed-pan  becomes  necessary.  Bed- 
pans  are  made  of  stoneware  or  metal,  and  are  of  various  shapes.  The 
most  convenient  kind  is  the  slipper  shape  (Fig.  11)  made  in  white  stone¬ 
ware,  or  a  modification  of  this  known  as  the  Anatomical  Bed-pan.  For 
comfort  in  use,  it  is  usual  to  make 
for  the  bed-pan  one  or  two  remova¬ 
ble  flannel  covers,  which  can  be 
taken  off  and  washed  when  neces¬ 
sary. 

Another  appliance  very  desirable 
and  useful  is  an  invalid  bed-bath,  an 
illustration  of  which  is  shown  on 

page  66  (Fig.  12).  Its  use  obviates  bed-plan  slipper. 

the  fatigue  which  often  follows  the 


Fig.  11. 


attention  of  the  nurse  to  perfect  cleanliness,  and  enables  her  to  perform 
her  duties  thoroughly  without  any  risk  of  rendering  the  bed  damp  or 
uncomfortable.  The  best  bed-baths  are  made  of  japanned  tin,  and  are 
filled  at  the  lower  end  with  a  waste-pipe  and  tap  attached  to  an  india- 
rubber  tube,  the  other  end  of  which  is  carried  to  a  receptacle  on  the 
floor.  By  leaving  the  tap  of  the  waste-pipe  open,  any  quantity  of  water 
can  be  used  for  washing  or  douching  without  any  risk  of  the  bed-bath 
overflowing,  the  overflow  being  carried  away  by  the  waste-pipe  into 
the  larger  vessel  on  the  floor. 

In  addition  to  ordinary  washing  after  confinement,  most  doctors  at 
the  present  time  insist  upon  daily  douching  of  the  vagina  by  the  nurse 
with  some  antiseptic  fluid  ;  and  for  this  purpose  either  a  family  syringe, 
such  as  is  described  at  page  33,  or  a  fountain  syringe  of  the  kind  pict¬ 
ured  iu  Fig.  13,  page  66,  is  necessary.  The  latter  is  the  more  convenient 
of  the  two  for  the  purpose  indicated.  It  consists  of  a  rubber  vessel,  of 
capacity  sufficient  to  hold  at  least  a  quart,  to  the  lower  end  of  which  is 
attached  a  flexible  india-rubber  tube  of  about  six  feet  in  length,  teimi- 
nating  in  a  gum-elastic  perforated  nozzle,  such  as  is  used  with  the 
family  syringe,  with  a  stop-cock  about  six  inches  from  the  end.  A  nail 
or  hook  upon  which  it  can  be  hung  when  in  use  should  be  fastened  to 
the  wall,  about  three  feet  above  the  left  side  of  the  head  of  the  bed. 


3 


— i 


66 


PREPARATIONS  FOR  CONFINEMENT. 


The  advantage  the  douche  possesses  over  the  syringe  is,  that  when  the 
vessel  has  been  filled  with  water  or  antiseptic  lotion  and  suspended  on 
the  hook,  the  fluid  runs  through  the  tube,  and,  when  the  stop-cock  is 
opened,  out  of  the  nozzle,  without  any  action  on  the  part  of  the  nurse, 
who  has  thus  both  her  hands  free  for  other  purposes  ;  while  in  the  use 

Fro.  12. 


BED-BATH. 


of  the  syringe  one  hand  is  occupied  with  propelling  the  fluid  by  pres¬ 
sure,  and  only  one  hand  is  left  available  for  other  services. 

One  or  two  sponges  are  necessary  for  use  in  the  ablution  of  the 
mother  and  the  baby.  The  same  sponge  should  not  be  used  for  both  ; 

13  and  when  ordinary  sponges  are  employed,  great 

care  must  be  taken  that  they  are  absolutely 
clean.  A  satisfactory  method  of  insuring  their 
freedom  from  possibly  contaminating  germs  is  to 
leave  them  lying  in  a  solution  of  carbolic  acid, 
composed  of  one  part  of  carbolic  acid  to  twenty 
parts  of  water,  for  twenty-four  hours,  after  they 
have  been  thoroughly  washed  out  in  warm 
water.  Much  preferable  to  ordinary  sponges  for 
the  mother  are  the  artificial  sponges  now  made 

FAMILY  SYRINGE.  .  ,  .  Z.  .  .  . 

of  absorbent  cotton-wool  enclosed  in  antiseptic 
gauze.  Each  sponge  of  this  kind  is  only  to  be  used  once  and  then 
destroyed  ;  but  as  their  cost  is  very  little,  their  use  is  not  expensive,  and 
all  risk  of  septic  poisoning  from  a  dirty  sponge  is  avoided. 

For  the  absorption  of  the  discharge  which  comes  from  the  vagina 
for  some  time  after  confinement,  most  women  use  ordinary  diapers ; 
and  if  these  are  thoroughly  clean,  and  of  soft  material,  they  answer  the 
purpose  very  well.  More  comfortable  and  convenient  are  the  sanitary 
towels,  or  absorbent  wool  diapers,  made  on  the  same  principle  as  the 
artificial  sponges  described  above.  These,  like  the  sponges,  are  now 
sold  by  the  dozen  at  a  very  low  price,  and  their  use  not  only  adds  to  the 
safety  and  comfort  of  the  patient,  but  also  obviates  the  necessity  of 
much  washing  of  diapers. 


REQUISITES  FOR  THE  INFANT. 


67 

After  confinement,  it  is  usual  for  the  mother  to  be  bound  round 
the  abdomen  for  two  or  three  weeks  with  a  broad  binder ,  which  affords 
support  to  the  abdominal  muscles  weakened  by  the  distention  of  the 
previous  months  of  pregnancy.  The  two  qualities  required  in  a  binder 
are  firmness  and  softness.  The  best  material  for  them  is  somewhat 
stiff  toweling ;  and  they  should  be  made  long  enough  to  just  mieet 
round  the  abdomen  before  confinement,  so  that  the  ends  may  overlap 
after  confinement,  and  broad  enough  to  extend  from  below  the  hip  to 
an  inch  or  two  above  the  lowest  rib.  Belts  fitted  with  buckles,  to  be 
used  in  place  of  the  ordinary  binder,  are  sold  by  surgical  instrument 
makers  ;  but  these  have  no  advantages  over  the  binder  as  just  described. 
The  binder,  when  adjusted  .after  confinement,  is  secured  by  strong 
safely  pins,  a  supply  of  which  should  be  kept  beside  the  binder.  Three 
or  four  binders  are  necessary,  as  they  may  become  soiled  and  require 
to  be  washed. 

The  use  of  Antiseptic  fluids  for  bathing  and  douching  after  con¬ 
finement  is  now  almost  universal.  Medical  men  differ  in  their  prefer¬ 
ence  for  particular  antiseptics,  and  it  is  well  for  the  expectant  mother 
to  ask  her  medical  attendant  which  antiseptic  he  recommends.  The 
most  commonly  used  is  carbolic  acid,  diluted  to  the  extent  of  one  part 
of  the  fluid  to  forty  parts  of  water.  [Soap  No.  33,  offered  by  Dr.  Foote  s 
Sanitary  Bureau,  is  an  excellent  antiseptic  soap  for  use  in  preparing 
a  vaginal  douche,  or  for  cleansing  the  outer  parts  before  and  after 
confinement.  See  page  1230.] 

A  feeding-cup,  a  small  pot  of  ccirbolized  vaseline,  some  scent,  and 
ordinary  toilet  requisites  will  complete  our  list  so  far  as  the  wants  of 
the  mother  are  concerned. 

Requisites  for  the  Infant. — For  the  expected  baby  some  prepar¬ 
ation  also  falls  to  be  made.  For  convenience  in  washing  the  baby,  it  is 
not  uncommon  to  have  a  special  baby’s  bath,  about  the  size  of  an  ordi¬ 
nary  foot-bath,  but  much  more  shallow,  which  is  fitted  into  a  stand 
about  a  foot  high,  from  which  it  can  be  removed  to  be  emptied  and 
cleaned.  Such  a  bath  is  not  absolutely  necessary,  as  an  ordinary  foot¬ 
bath,  or  even  a  large  basin,  is  sufficient  for  the  purpose  ;  but  its  posses¬ 
sion  conduces  to  the  comfort  of  the  nurse,  and  avoids  the  risk  of  an}r 
injury  to  the  baby,  such  as  may  happen  from  contact  with  the  sides 
when  a  foot-bath  is  employed. 

Any  kind  of  good  soap  may  be  employed  for  washing  the  baby. 
[Dr.  Westland  names  some  English  soaps  which  are  not  obtainable  in 
this  country.  Soap  No.  31,  offered  in  the  list  of  the  Sanitary  Bureau, 
on  page  1230,  is  one  of  the  good  ones.] 

For  drying  the  baby  after  it  has  been  washed,  the  softest  Turkish 
towels  should  be  used  ;  and  after  thorough  drying,  the  baby  is  pow¬ 
dered  with  some  soft  powder,  such  as  Fullers  earth,  starch  powder,  ov 


68 


PREPARATIONS  FOR  CONFINEMENT. 


so-called  violet  powder.  [A  very  pleasantly  scented  and  soft  powder 
useful  for  this  purpose  is  offered  as  No.  37,  of  the  Sanitary  Bureau 
list  of  toilet  articles  described  on  page  1230.] 

It  is  unnecessary  here  to  enter  into  the  question  of  the  baby’s  cloth¬ 
ing  ;  something  will  be  said  later  on  the  matter  ;  but  the  importance  of 
softness  and  dryness  in  the  diapers  for  the  use  of  the  baby  require  that 
mention  should  be  made  of  the  best  material  for  their  construction. 
This  is  undoubtedly  soft  Turkish  toweling.  This  material  is  soft,  ab¬ 
sorbent,  easily  washed,  and  retains  its  softness  even  after  frequent 
washing  ;  and  is  much  to  be  preferred  in  every  way  to  linen,  cotton,  or 
calico.  Lately,  diapers  of  absorbent  cotton- wool  have  been  introduced 
for  the  use  of  babies,  but  they  are  ineligible  on  account  of  their  exces¬ 
sive  warmth.  India-rubber  waterproof  sheeting  should  never  be  used  as 
an  outside  covering  to  diapers.  Its  use  simply  affords  an  excuse  for  the 
nurse  not  changing  the  diapers  as  often  as  necessary,  and  interferes 
with  the  healthy  action  of  the  child’s  skin,  not  unfrequently  setting  up 
acute  irritation  of  the  legs  and  lower  part  of  the  abdomen. 

It  is  convenient  to  have  the  bassinette  or  cradle,  which  is  prepared 
for  the  baby,  of  such  a  size  and  shape  as  to  be  easily  portable.  When 
the  mother  has  so  far  recovered  as  to  be  able  to  move  from  one  room  to 
another,  it  is  convenient  to  have  both  baby  and  bassinette  in  the  room 
to  which  she  may  have  removed  ;  and  a  heavy  and  cumbrous  bassinette 
is  difficult  and  awkward  to  carry.  Babies  undoubtedly  rest  with  more 
comfort  in  a  small  than  in  a  large  bassinette,  as  it  is  more  easy  in  a 
small  one  to  give  them  the  support  they  desire,  and  to  maintain  their 
warmth.  When  a  baby  is  lying  down,  it  is  often  uncomfortable  unless 
supported  on  either  side  by  small  pillows  or  blankets ;  and  when  the 
bassinette  is  too  wide  it  is  difficult  to  give  this  support.  Rocking-cradles 
are  scarcely  ever  employed  now  ;  and  the  propriety  of  swinging  or 
rocking  babies  to  sleep  is  questionable,  probably  interfering  to  some 
extent  with  healthy  digestion.  There  is  no  objection  to  the  use  of  cur¬ 
tains  to  a  bassinette,  except  in  so  far  as  they  diminish  its  portability  ; 
and  besides  adding  to  its  appearance,  they  are  useful  in  screening 
light  and  preventing  draughts.  It  is  usual  to  place  the  various  articles 
required  for  the  baby’s  toilet  in  an  open  basket,  so  that  they  be  imme¬ 
diately  available  when  wanted.  The  contents  of  the  basket  will  include 
needles  and  thread,  scissors,  safety  and  other  pins,  some  tape,  a  skein 
of  strong  cotton  thread,  flannel  and  other  rollers,  some  flannel  for 
washing  baby,  a  little  old  linen,  a  small  hair-brush,  a  powder-box  with 
small  puff  [a  box  of  Sanitary  Powder,  No.  37,  a  cake  of  soap,  No.  31, 
and  a  pot  of  Magnetic  Ointment,]. 

Preparation  of  the  Bed. — For  the  purpose  of  protecting  the  bed 
from  being  soiled  during  confinement,  some  waterproof  sheeting  is  desir¬ 
able,  It  is  best  to  have  two  pieces  of  sheeting — one  large  enough  to 


PREPARATION  OF  THE  BED. 


69 

cover  almost  the  whole  of  the  bed,  measuring  about  six  feet  by  five 
feet ;  the  other  not  quite  so  large,  about  four  feet  by  three  feet.  At 
the  commencement  of  the  confinement  the  bed  is  arranged  in  the  fol¬ 
lowing  manner.  The  large  waterproof  sheet  is  spread  above  the  mat¬ 
tress,  and  covered  with  a  blanket,  over  which  the  under  sheet  is  placed. 
Upon  this  the  smaller  waterproof  sheet  is  laid  in  such  a  way  that  one 
end  hangs  a  little  over  the  left  side  of  the  bed,  while** the  other  end 
extends  rather  beyond  the  middle  line,  the  sides  of  the  sheet  being 
equidistant  from  the  top  and  bottom  of  the  bed.  This  smaller  sheet  is 
then  covered  with  a  folded  blanket,  and  over  this  is  laid  a  sheet  folded 
lengthways,  so  as  to  be  about  three  feet  wide.  One  end  of  this  “draw- 
sheet,”  as  it  is  called,  hangs  over  the  left  side  of  the  bed,  covering  the 
waterproof  sheet ;  the  other  end  is  rolled  up  so  as  to  lie  in  the  middle 
line  of  the  bed,  near  the  farther  end  of  the  waterproof  sheet  beneath  it. 
The  object  gained  by  this  arrangement  is  that  both  the  bed  and  the 
patient  can  be  kept  thoroughly  dry.  The  larger  waterproof  sheet 
protects  the  bed  completely  from  any  risk  of  becoming  damp  ;  and  the 
draw-sheet  over  the  smaller  waterproof  sheet  can  be  pulled  through 
gradually  from  right  to  left,  so  that,  when  the  left  side  becomes  soiled, 
it  may  be  folded,  and  the  unused  part  rolled  up  in  the  middle  of  the 
bed  brought  into  use.  When  the  confinement  is  completed,  the  draw- 
sheet,  with  the  folded  blanket  underneath  and  the  smaller  waterproof 
sheet,  can  be  removed  without  any  trouble  or  fatigue  to  the  mother, 
and  a  perfectly  comfortable  and  dry  bed  is  presented  at  once.  Draw- 
sheets  made  of  absorbent  cotton-wool  enclosed  in  antiseptic  gauze  have 
lately  been  introduced,  and  are  both  economical  and  comfortable. 
After  use  they  are  destroyed  by  burning. 

Precaution. — As  the  time  of  confinement  approaches,  it  is  very 
important  for  the  expectant  mother  to  give  attention  to  the  regular  and 
daily  action  of  the  bowels.  This  may  be  secured  by  the  use  of  com¬ 
pound  licorice  powder,  or  of  any  other  of  the  aperients  mentioned 
previously.  It  is  not  necessary  or  desirable  to  take  the  rather  nauseous 
popular  medicine,  castor-oil,  habitually  toward  the  end  of  gestation  ; 
but  in  first  confinements,  when  the  process  of  parturition  has  actually 
commenced,  a  small  tablespoonful  of  castor-oil  may  be  taken  with 
advantage,  and  is  useful  both  in  promoting  the  progress  of  the  confine¬ 
ment,  and  in  diminishing  the  severity  of  the  pains. 


CHAPTER  VIII 


Confinement. 

Definition;  Indications  of  Commencement;  Painful  Contractions  of  Womb; 
Frequency;  Distinction  from  “  False  Pains”;  the  Show;  Demeanor  dur¬ 
ing  First  Stage;  Propriety  of  Laxative  Medicine;  Food;  Transition  from 
“  First  Stage  ”  to  “  Second  Stage  ”;  Description  of  Contents  of  Womb,  and 
of  Action  during  Labor;  Bursting  of  the  Waters;  Second  Stage;  Differing 
Character  of  Pains;  Position  of  Mother;  Termination  of  Second  Stage; 
Position  of  Child;  Management  in  Absence  of  Skilled  Assistance;  Third 
Stage;  General  Remarks. 

The  term  confinement  apparently  was  originally  employed  to  repre¬ 
sent  the  whole  period  during  which  a  mother  was  withdrawn  from  her 
usual  occupations  by  the  act  of  giving  birth  to  a  child  ;  but  it  is  now 
used  in  the  more  limited  sense  as  a  synonym  for  the  actual  process  of 
parturition.  This  process  is  generally  reckoned  as  commencing  at  the 
time  that  the  first  painful  contractions  of  the  womb  are  experienced, 
and  as  finishing  when  the  fleshy  body  known  as  the  “after-birth”  has 
come  away  with  its  attached  membranes,  which  generally  immediately 
follows  the  birth  of  the  child.  As  a  matter  of  fact,  however,  the  pro¬ 
cess  of  parturition  often  commences  considerably  before  any  painful 
contractions  or,  as  they  are  generally  called,  “uterine  pains”  are  felt. 
The  initial  contractions  of  the  womb  at  the  commencement  of  confine¬ 
ment,  are  not  un frequently  painless,  more  especially  in  women  who 
have  already  had  one  or  two  children  ;  and  even  in  first  confinements 
the  early  efforts  of  the  womb  to  expel  its  contents  may  be  accompanied 
with  so  little  discomfort  that  quiet  sleep  is  not  interfered  with. 

The  'painful  contractions  of  the  womb,  which  first  indicate  to  the 
expectant  mother  the  near  approach  of  the  termination  of  her  preg¬ 
nancy,  resemble  very  closely  the  spasms  of  ordinary  colic.  They  are 
of  short  duration,  lasting  usually  from  a  quarter  to  half  a  minute  ; 
and  the  intervals  between  them  often  extend  to  half  an  hour,  or  even 
to  an  hour.  Sometimes  they  are  felt  in  the  back,  but  more  commonly 
in  the  front  of  the  abdomen  ;  and  each  painful  contraction  generally 
returns  in  the  same  part  of  the  abdomen  as  the  previous  one,  a  distinc¬ 
tion  being  afforded  in  this  respect  from  the  pains  of  colic,  which  are 

apt  to  be  felt  at  different  points  in  the  interior  of  the  abdomen. 

70 


FALSE  AND  TRUE  LABOR  PAINS. 


71 


True  uterine  contractions  have  also  to  be  distinguished  from  what 
are  known  as  false  pains,  which  occasionally  give  some  annoyance  for 
one  or  two  weeks  before  confinement  occurs.  These  “  false  pains”  are 
actually  contractions  of  a  spasmodic  character  of  a  small  part  of  the 
womb,  of  a  character  analogous  to  the  cramp  which  affects  sometimes 
so  painfully  the  muscles  of  the  calf  of  the  leg.  Just  as  in  cramp  of  the 
leg,  the  part  of  the  muscle  contracted  is  too  small  to  produce  any 
movement  of  the  feet,  so  the  irregular  spasmodic  action  of  the  part  of 
the  womb  contracted  by  a  false  pain  is  too  small  to  produce  any  effect 
with  reference  to  the  birth  of  the  child  ;  and  the  contraction  is  thus  a 
useless  and  a  “false  ”  one.  There  are  three  tests  available  to  the  invalid 
to  enable  her  to  distinguish  true  uterine  contractions  from  colic  and 
from  “  false  pains.” 

1.  The  first  is  the  coincidence  with  the  pain  of  the  general  hard¬ 
ening  and  increase  of  firmness  of  the  womb  felt  through  the  walls  of 
the  abdomen,  as  described  in  the  previous  chapter  (page  47).  This  can 
generally  be  made  out  distinctly  when  the  invalid  lies  on  her  back  dur¬ 
ing  the  occurrence  of  the  pain. 

2.  The  second  test  is  the  appearance  of  a  discharge  from  the 
vagina  tinged  with  blood,  which  is  known  as  a  “ s7iow.”  With  some 
■women  this  appears  early,  with  others  late,  and  with  others  not  at  all ; 
but  when  it  does  appear  it  is  positive  evidence  of  the  actual  commence¬ 
ment  of  the  process  of  parturition. 

3.  The  third  test  is  found  in  the  effect  of  a  moderate  dose  of  cas¬ 
tor-oil.  The  pains  of  colic  are  generally  alleviated,  and  false  pains 
usually  cease  altogether  for  some  time  after  the  action  of  the  oil ; 
whereas  the  true  uterine  contractions  of  parturition  are  generally  aided 
and  increased  by  its  operation. 

Additional  probability  to  the  true  contractile  character  of  the  pains 
is  given  by  the  regularity  of  the  intervals  between  them,  by  the  gradual 
shortening  of  these  intervals,  and  by  the  progressive  increase  in  the 
intensity  and  duration  of  the  pain.  In  a  first  confinement,  these  uterine 
contractions  may  progress  for  many  hours  without  being  sufficiently 
severe  ta  prevent  the  patient  from  moving  about  the  house;  and  as  a 
rule  she  will  feel  more  comfortable,  and  the  confinement  will  progress 
more  satisfactorily,  if  she  continues  walking  about  a  room  or  sitting  in 
a  chair,  rather  than  lying  in  bed.  If  the  bowels  have  not  been  acted 
on  freely  within  six  hours  before  the  commencement  of  the  pains,  it  is 
most  desirable  that  action  should  be  obtained  at  this  stage  of  the  con¬ 
finement,  either  by  a  dose  of  castor-oil,  or  preferably  by  the  aid  of  a 
large  enema  of  warm  water.  Nothing  conduces  more  to  increase  the 
rapidity,  as  well  as  to  diminish  the  discomfort  of  confinement,  than  a 
thoroughly  empty  condition  of  the  lower  bowel  ;  and  this  is  best 
effected  by  a  large  enema  of  warm  water  given  slowly. 


72 


CONFINEMENT. 


Food  may  be  taken  as  usual  during  the  progress  of  this  stage  of 
confinement ;  but  no  stimulants  of  any  kind  should  be  taken  from  the 
commencement  unless  by  the  direct  order  of  the  medical  attendant. 
Not  unfrequently  the  inclination  for  food  is  diminished  by  the  presence 
of  sickness,  and  when  that  is  present  it  is  best  to  take  only  simple 
fluids  [such  as  simple  gruel,  Zoolak,  Kumyss]  or  milk  with  soda- 
water.  Sickness,  although  unpleasant,  is  not  at  all  injurious  in  the 
early  period  of  confinement  ;  indeed,  in  many  cases  it  facilitates  the 
progress  of  the  parturition  by  relaxing  resisting  tissues  ;  and  for¬ 
merly  it  was  not  unusual  to  administer  emetics  such  as  ipecacuanha 
and  antimony  for  this  purpose. 

After  a  period  of  time  varying  very  much  with  different  women, 
and  in  different  confinements,  the  pains  are  generally  observed  to 
change  somewhat  in  character,  and  from  being  spasmodic  and  griping 
they  become  forcing  and  down-bearing.  This  change  is  coincident 
with  progress  from  what  medical  men  call  the  first  stage  to  the  second 
stage  of  parturition.  Just  before  confinement  commences,  the  womb 
exists  in  the  form  of  a  large  oval  bag,  with  a  very  narrow  and  small 
neck  at  its  lower  end.  The  interior  of  this  bag  is  lined  with  what  are 
known  as  the  “membranes,”  and  these  enclose  the  watery  fluid  in 
which  the  infant  floats.  The  sole  connection  of  the  infant  with  the 
mother,  independently  of  the  fluid  surrounding  it,  is  the  umbilical  cord, 
which  proceeds  from  the  navel  of  the  infant  to  some  part  of  the  wall 
of  the  womb,  where  it  is  attached  to  the  after-birth  or  placenta,  as  it  is 
called.  The  placenta  is  a  flattened  and  fleshy  cake  lying  between  the 
membranes  and  the  interior  of  the  womb  at  some  part  of  its  inner  sur¬ 
face,  and  at  this  period  of  gestation  is  so  loosely  attached  to  the  womb 
as  to  separate  easily  from  it  after  the  infant  is  born.  During  the  first 
stage  of  labor,  the  womb,  by  its  successive  contractions,  is  forcing  part 
of  the  membranous  bag  with  its  enclosed  fluid  into,  and  partly  through, 
the  small  and  narrow  neck  of  the  womb,  and  the  neck  is  thus  dilated  to 
admit  of  the  subsequent  passage  of  the  infant.  This  stage  is  said  to  be 
completed  when  the  neck  and  mouth  of  the  womb  have  been  dilated  to 
their  full  extent  so  as  to  afford  a  continuous  passage  with  the  vagina 
for  the  birth  of  the  child.  At  the  end  of  the  first  stage  usually,  but 
sometimes  earlier,  sometimes  later,  the  membranes  generally  tear,  and 
the  greater  part  of  the  enclosed  fluid  is  discharged  from  the  vagina. 
This  discharge  is  generally  described  by  nurses  as  the  bursting  of  the 
waters,  and  is  often,  although  not  quite  accurately,  regarded  as  an  indi¬ 
cation  of  the  commencement  of  the  “  second  stage.”  It  is  always  an 
indication  that  some  progress  in  labor  has  been  made  ;  but  it  is  not  at 
all  uncommon  for  the  membranes  to  tear  some  time  before  the  neck  of 
the  womb  has  been  fully  dilated,  and  thus  some  time  before  the  “first 
stage”  has  been  technically  completed.  The  amount  of  fluid  which 


THE  SECOND  STAGE. 


73 


escapes  varies  extremely,  depending  both  upon  the  amount  actually 
contained  in  the  womb,  and  upon  the  proportion  which  is  allowed  to 
escape  under  differing  conditions  of  the  neck  of  the  womb,  and  of  the 
position  of  the  child  within  the  womb.  In  a  few  exceptional  cases  it 
may  amount  to  some  gallons,  flooding  the  bed,  and  even  the  floor  of  the 
room  ;  in  the  majority  of  cases,  one  or  two  pints  may  be  discharged 
either  at  once,  or  at  short  intervals  of  time.  If  the  “bursting  of  the 
waters”  does  not  occur  till  toward  the  end  of  the  first  stage,  the 
patient  will  probably  be  in  bed  ;  and  the  uncertainty  about  the  amount 

Fig.  14. 


PLACENTA  AND  UMBILICAL  CORD. 

affords  a  strong  reason  for  thorough  protection  of  the  bed  by  water¬ 
proof  sheeting. 

When  the  second  stage  has  been  reached,  the  contractile  pains  are 
usually  of  a  distinctly  more  forcing  and  down-bearing  character.  They 
recur  usually  with  great  regularity,  the  length  of  interval  between 
them  varying  much  in  different  confinements.  As  a  rule,  the  intervals 
are  from  three  to  ten  minutes,  generally  becoming  rather  shorter  as  the 
confinement  approaches  its  termination.  During  this  stage,  which  may 
last  for  several  hours,  more  especially  in  first  confinements,  but  which 
is  occasionally  passed  through  in  a  few  minutes,  the  patient  will  gener¬ 
ally  be  most  comfortable  lying  in  bed  ;  and  as  she  herself  is  not  aware 
of  the  rapidity  of  progress,  it  is  unsafe  to  get  up  without  the  doctor’* 
8a 


74 


CONFINEMENT. 


permission,  as  the  birth  of  the  child  may  take  place  suddenly,  and 
injury  may  follow  if  the  mother  is  out  of  bed. 

The  second  stage  of  labor  terminates  with  the  birth  of  the  child. 
Most  usually,  the  head  of  the  child  emerges  first,  and  is  followed  by 
the  body  and  legs  ;  but  in  some  cases  the  feet  come  first,  or  the  breech 
of  the  child  ;  and  in  these  instances  the  head  comes  last.  When  first 
born,  the  infant  still  remains  attached  to  the  mother  by  the  cord  which 
proceeds  from  the  navel  of  the  child  to  its  attachment  to  the  after¬ 
birth  adhering  to  the  interior  wall  of  the  womb.  Immediately  the  child 
is  born,  the  doctor  or  nurse  sees  that  its  breathing  is  not  impeded  in 
any  way  by  its  mouth  being  covered  with  blankets,  or  immersed  in  any 
discharge  ;  and  proceeds  to  separate  it  from  the  mother  by  tying  the 
cord  with  thread  in  two  places  about  an  inch  apart,  and  two  or  three 
inches  distant  from  the  child,  and  cutting  it  through  with  scissors 
between  the  two  threads. 

In  cases  where  a  child  has  been  born  hurriedly,  and  neither  nurse 
nor  doctor  is  present  to  afford  assistance,  the  mother  should  lie  quite 
quietly  with  the  infant  in  front  of  her,  simply  taking  care  that  its 
breathing  is  not  impeded  in  any  way.  No  injury  whatever  results  to 
the  child  from  remaining  attached  to  the  mother  by  the  umbilical  cord 
for  some  time  after  birth  ;  and  if  it  is  allowed  to  breathe  freely  and  is 
kept  warm,  it  may  remain  in  perfect  safety  until  assistance  arrives. 

What  is  known  as  the  third  stage  of  labor  consists  of  the  expulsion 
from  the  womb  and  vagina  of  the  placenta,  or  after-birth,  and  the 
attached  membranes  which  previously  lined  the  interior  of  the  womb. 
After  the  birth  of  the  child,  the  womb  contracts  very  much  in  size  ; 
and  this  contraction  loosens  the  attachment  of  the  after-birtli  to  the 
interior  wall  of  the  womb.  A  few  intermittent  contractile  pains  follow, 
and  after  a  short  period,  varying  usually  from  five  to  twenty  minutes, 
the  after-birth  is  pushed  out,  carrying  with  it  the  membranes,  and  the 
labor  is  thus  completed. 

The  contractile  pains  which  expel  the  after-birtli  are  generally  of  a 
very  mild  character,  and  not  irksome  to  the  mother  ;  and  after  the 
expulsion  has  been  effected,  there  is  generally  complete  freedom  from 
pain,  and  a  delightful  sense  of  comfortable  rest.  Occasionally,  there 
is  some  delay  in  the  expulsion  of  the  after-birtli,  and  some  little  assist¬ 
ance  may  have  to  be  given  by  the  doctor  in  attendance  ;  but  that  is  not 
a  matter  which  will  materially  affect  the  patient’s  comfort. 

The  expulsion  of  the  after-birth  is  generally  accompanied  by  some 
discharge  of  blood,  which,  however,  usually  ceases  almost  immediately  ; 
to  be  followed  soon  by  the  discharge  which  continues  for  the  first  two 
or  three  weeks  of  convalescence.  To  receive  this  a  sanitary  towel  or 
diaper  is  usually  adjusted  immediately  after  the  confinement  is  com¬ 
pleted  ;  and  when  the  draw-sheet  and  upper  waterproof  sheet  have 


PAINLESS  PARTURITION. 


75 


been  removed,  a  binder  is  pinned  carefulty  round  the  abdomen  of  the 
patient,  and  she  is  at  liberty  to  rest  and  sleep.  If  the  discharge  is 
excessive  in  quantity,  it  is  convenient  to  replace  the  draw-sheet,  but 
this  is  not  usually  necessary. 

It  is  desirable  and  convenient  to  point  out  here  that  parturition  is 
a  perfectly  natural  process,  for  which  the  mother  has  been  under¬ 
going  preparation  during  the  whole  of  the  previous  pregnancy.  Vari¬ 
ous  alterations  have  been  taking  place  during  that  period  both  in  the 
joints  of  the  pelvis  and  in  the  tissues  of  related  parts,  so  as  to  admit  of 
the  passage  of  the  child  when  the  period  of  gestation  has  been  com 
pleted  ;  and  these  temporary  changes  in  the  majority  of  cases  fulfil 
their  object  so  satisfactorily,  that  the  duty  of  the  medical  man  is  lim¬ 
ited  to  ministering  to  the  comfort  of  the  mother  and  guarding  the  safety 
of  the  child.  The  amount  of  pain  experienced  by  the  mother  varies 
very  much  ;  in  all  cases  a  certain  amount  of  pain  has  to  be  borne  ;  but 
since  the  introduction  by  Sir  James  Y.  Simpson  of  anaesthesia  by  chlor¬ 
oform  in  midwifery,  the  pain  can  always  be  kept  within  reasonable 
limits ;  and  where  necessary  the  mother  can  be  made  absolutely  and 
completely  unconscious.  The  propriety  of  using  chloroform  in  partic¬ 
ular  cases,  and  the  extent  of  anaesthesia  demanded,  must  always  be  de¬ 
cided  by  the  medical  man  in  attendance  ;  and  a  judicious  patient  will 
be  guided  by  his  advice.  The  tendency  of  the  present  day  is  probably 
toward  excess  in  the  use  of  chloroform  during  confinements,  as,  natur¬ 
ally,  medical  men  are  always  anxious  to  reduce,  as  far  as  possible,  the 
pain  borne  by  their  patients. 


)  ■ 


PART  II. 


EARLY  MOTHERHOOD. 


CHAPTER  IX. 


Convalescence  from  Confinement. 

Normal  Progress  after  Confinement:  Necessity  of  Quietude;  Injurious  Effects 
of  Excitement;  After-pains;  Diet  after  Confinement;  Occasional  Occur¬ 
rence  of  Sickness;  Aperients;  Discharge;  Occasional  Excess  of  Discharge; 
Management;  Necessity  of  Cleanliness;  Methods  of  Douching  and  Syring¬ 
ing;  Maintenance  of  Recumbent  Position;  Summary  of  Normal  Progress; 
Application  of  Binder;  Alteration  of  Figure  after  Confinement;  Desquama¬ 
tion  of  Skin;  Deepening  of  Color  of  Hair;  Occasional  Occurrence  of  Fever¬ 
ishness;  Necessity  of  Medical  Aid;  Susceptibility  to  Infection  during 
Convalescence. 


The  Period  of  Convalescence  after  Confinement  is  usually  a 

very  pleasant  one  for  the  young  mother.  The  trials  and  troubles  of 
pregnancy  are  passed,  parturition  has  been  successfully  accomplished, 
and  a  new  interest  has  been  added  to  life  in  the  possession  of  offspring 
which  requires  and  calls  for  the  loving  care  and  attention  of  the 
mother.  If  still  some  little  sacrifice  of  personal  inclinations  has  to  be 
made,  and  some  minor  discomforts  borne  with  equanimity,  the  reward 
in  the  pleasure  of  fulfilling  maternal  duties  is  more  than  an  equivalent, 
and  daily  the  interest  of  such  duties  will  be  found  to  increase. 

Usually,  after  the  immediate  attentions  of  the  nurse  have  been  ren¬ 
dered  to  the  mother  after  childbirth  as  described  in  the  previous  chap¬ 
ter,  a  period  of  complete  rest  and  delicious  comfort  ensues.  Peaceful 
sleep  is  enjoyed,  and  for  from  twelve  to  twenty-four  hours  the  less  the 
patient  is  disturbed  for  any  purpose,  except  for  the  necessary  changes 
of  diapers  when  the  discharge  is  considerable,  and  for  the  administra¬ 
tion  of  nourishment,  the  better  her  progress  will  subsequently  be. 
Occasionally,  for  the  first  few  hours,  there  is  a  feeling  of  excitement 
and  nervousness,  sometimes  accompanied  by  attacks  of  shivering  ;  these 


CONVALESCENSE. 


QUIET;  AFTER  PAINS;  DIET. 


77 


discomforts  will  be  found  to  be  allayed  completely  by  quietness  and 
subdued  light  in  the  room,  by  warmth  of  covering,  and  by  the  admin¬ 
istration  of  light  warm  food,  such  as  gruel  or  beef-tea. 

Importance  of  Quiet. — Even  in  the  absence  of  any  discomfort  or 
excitement,  complete  quietude  is  most  essential  for  the  satisfactory 
progress  of  the  young  mother.  Slight  influences  have  strong  effects 
during  the  convalescence  from  confinement,  and  even  the  excitement  of 
seeing  one  or  two  friends  is  not  unfrequently  followed  by  disturbing 
symptoms.  A  rule  upon  which  many  doctors  act,  and  which,  although 
perhaps  apparently  rather  stringent,  is  exceedingly  beneficial,  is  to  per¬ 
mit  of  no  visitors  whatever,  with  the  exception  of  one  relative  or  inti¬ 
mate  friend,  once  daily,'  during  the  whole  of  the  first  week  after 
confinement. 

Different  women  nathrally  differ  very  much  in  susceptibility  to 
disturbance  of  this  kind,  and  ill  results  from  excitement  are  not  so  apt 
to  follow  second  or  later  confinements  ;  but  with  slight  occasional  relax¬ 
ation,  the  observance  of  the  rule  will  be  found  advantageous. 

After=  Pains. — After  twelve  or  twenty-four  hours  have  elapsed, 
young  mothers  are  occasionally  troubled  to  some  extent  with  the 
periodic  pains  which  are  known  as  ‘‘after-pains.”  These  are  slight 
rhythmical  pains  occurring  at  varied  intervals,  and  resembling  the 
pains  which  occur  at  the  commencement  of  confinement.  They  are 
caused  by  spasmodic  contractions  of  the  now  empty  womb.  The 
majority  of  primiparae  escape  them  altogether,  but  they  are  generally 
experienced  to  some  extent  by  mothers  who  have  had  two  or  more 
children.  After  their  commencement,  they  may  continue  at  intervals 
for  two  or  three  days,  and  are  usually  complained  of  most  during  the 
night.  Much  can  be  done  to  relieve  them,  and  the  medical  attendant 
will  usually  administer  some  medicine  which  will  mitigate  their  sever¬ 
ity,  when  they  occur  to  such  an  extent  as  to  seriously  disturb  the  rest 
of  the  patient.  The  application  of  flannels  wrung  out  of  warm  water, 
or  of  a  warm  india-rubber  bottle  to  the  lower  part  of  the  abdomen, 
often  adds  much  to  the  comfort  of  the  mother  when  after-pains  are 
troublesome.  [Women  who  have  resorted  to  the  Magnetic  Ointment 
for  relief  of  after-pains  state  that  it  is  the  most  prompt  and  satisfactory 
remedy,  and  they  come  to  regard  it  as  one  of  the  “indispensable*”  for 
themselves  in  a  variety  of  uses  before  and  after  confinement,  as  well  as 
for  the  baby  and  its  common  ailments.  See  page  1228.] 

Diet  after  Confinement.— During  the  first  twenty  four  hours 
after  confinement,  the  mother  is  usually  restricted  to  a  light  fluid  diet 
consisting  generally  of  bread  and  milk,  gruel,  bread  and  butter,  tea, 
soups,  and  eggs  beaten  up  with  milk.  Many  medical  men  prefer  to  con¬ 
tinue  this  diet  for  the  first  three  or  four  days  after  parturition  ;  others 
allow,  after  the  first  day,  a  little  solid  food  in  the  form  of  white  fis.Uj 


CONVALESCENCE  FROM  CONFINEMENT. 


7S 

poultry,  or  game.  Unless  called  for  by  special  reasons,  stimulants  are 
usually  interdicted  for  at  least  the  first  three  or  four  days  after  confine- 
nient ;  after  that  period  the  question  of  stimulants  falls  to  be  decided 
by  habit,  temperament,  and  considerations  relative  to  the  nutrition  of 
the  infant. 

In  some  mothers  some  degree  of  weakness  of  digestion  exists  for  a 
few  days  after  confinement,  and  even  occasional  attacks  of  sickness 
may  be  experienced.  This  is  more  apt  to  occur  where  the  confinement 
has  been  prolonged,  or  where  the  mother  has  been  under  the  influence 
of  chloroform  for  some  time  during  the  parturition.  In  such  cases 
considerable  care  in  diet  may  be  necessary  for  a  few  days.  Milk  in 
combination  with  soda-water  is  pleasant  and  useful  when  nausea  is 
present  ;  when  digestion  is  feeble,  and  accompanied  by  flatulence  or 
pain,  a  well-made  soup  or  chicken-broth  will  be  found  both  nutritious 
and  easy  of  assimilation.  [With  some  a  dry  diet  of  chops  and  toast  is 
preferable  at  such  times.] 

In  the  absence  of  any  counter-indications,  the  young  mother  will 
usually  be  allowed,  after  the  first  three  or  four  days,  to  return  to  her 
usual  diet ;  and  any  precautions  or  restrictions  which  may  be  imposed 
will  be  dictated  rather  with  a  view  to  the  susceptibility  of  the  nursing 
infant  than  to  the  health  of  the  mother.  The  digestion  of  newly  born 
infants  is  very  easily  deranged,  and  imprudence  in  diet  in  the  mother 
will  frequently  result  in  great  pain  to  the  child,  producing  disturbed 
sleep  and  violent  fits  of  crying.  Something  will  be  said  in  the  next 
chapter  about  diet  in  relation  to  the  quality  of  milk  secreted  by  the 
breasts. 

Aperients  after  Confinement.— If  the  bowels  have  acted  freely 
immediately  before  confinement,  there  will  not  usually  be  any  further 
action  for  one  or  two  days  afterward;  and  no  discomfoit  will  be 
experienced  even  if  a  period  of  three  days  elapse  before  action  again 
takes  place.  If  an  aperient  is  then  necessary  to  insure  action,  it  is 
usual  to  employ  either  castor-oil,  or  compound  licorice  powder,  a  small 
dose  of  either  being  given  at  night.  [Those  who  have  not  ready  access  to 
drug  stores  where  compound  licorice  powder  may  be  had,  can  procure 
an  excellent  preparation  of  it  by  mail  from  Dr.  Foote’s  Sanitary 
Bureau.  For  address,  see  page  1228.] 

It  is  found  that  under  such  conditions  a  smaller  dose  chan  is 
usually  required  is  efficacious  ;  generally  one  dessert-spoonful  of  castor- 
oil  or  one  heaped-up  teaspoonful  of  compound  licorice  powder  will  be 
quite  sufficient  to  produce  a  good  action  of  the  bowels  in  the  morning. 
In  place  of  one  of  these  drugs,  an  enema  of  warm  water,  or  an  injec¬ 
tion  of  one  or  two  teaspoonfuls  of  glycerine  may  be  employed,  and 
will  generally  be  considered  more  pleasant;  and  be  found  equally 
effective,  The  choice  between  giving  a  drug  or  an  injection  will  some- 


DISCHARGE  AFTER  CONFINEMENT. 


79 


times  depend  on  the  condition  of  the  breasts  as  regards  tension  when 
the  secretion  of  milk  is  commencing.  If  the  breasts  are  tense  and  full 
and  uncomfortable,  action  of  the  bowels  by  castor-oil  or  compound 
licorice  powder  will  be  found  to  relieve  them  more  than  by  enema  or 
injection. 

The  amount  of  the  discharge  which  flows  from  the  womb 
after  confinement  varies  very  greatly  in  different  women  ;  and  it  is  a 
question  for  the  doctor  to  decide  whether  in  any  given  case  it  is  exces¬ 
sive,  and  should  be  restrained.  What  would  be  excessive  and  injurious 
to  one  mother  may  be  not  only  normal,  but  also  salutary,  to  another ; 
and  extreme  variations,  from  those  requiring  one  or  two  diapers  daily  to 
those  requiring  twelve  or  more,  are  observed  without  any  apparent  in¬ 
jury  to  health,  or  interference  with  convalescence.  It  is  the  duty  of  the 
nurse  to  watch  carefully  the  character  and  amount  of  the  discharge, 
and  to  report  at  once  any  abnormality  to  the  doctor  in  attendance. 
For  the  first  few  days  the  discharge  is  usually  of  a  character  almost 
indistinguishable  from  blood,  although  a  little  more  watery  than  nor¬ 
mal  blood,  It  has  a  characteristic,  faint,  but  not  unpleasant  odor  by 
which  it  can  be  recognized  on  a  diaper  as  distinct  from  ordinary  blood. 
After  a  few  days  it  alters  in  appearance,  becoming  rather  more  watery, 
and  changing  from  a  red  to  a  greenish  hue ;  after  which  it  becomes 
white  or  watery,  and  ultimately  disappears.  Generally,  it  will  have 
disappeared  almost  entirely  by  the  end  of  the  third  week  after  con¬ 
finement,  but  in  some  cases  it  may  last  for  four  or  five  weeks.  If  dis¬ 
charge  of  any  kind  lasts  more  than  five  or  six  weeks  after  confinement, 
it  is  an  indication  that  some  skilled  care  is  necessary,  and  the  attention 
of  the  medical  attendant  should  be  called  to  the  matter. 

Any  appearance  of  fetor  in  the  discharge  should  always  be  reported 
by  the  nurse  to  the  doctor.  A  normal  discharge  after  confinement,  if 
proper  cleanliness  is  preserved,  should  never  have  a  fetid  or  distinctly 
disagreeable  smell.  When  marked  fetor  exists,  it  is  an  indication  of 
possible  risk  to  the  mother  from  septic  contamination  ;  and  to  obviate 
this  risk  certain  precautions  will  require  to  be  taken  under  the  direction 
of  the  medical  attendant.  Undoubtedly,  fetor  does  exist  in  a  great 
many  instances  where  no  evil  effects  follow,  but  its  existence  should 
always  be  regarded  as  abnormal,  and  immediate  attention  given  to  im¬ 
prove  the  character  of  the  discharge,  and  prevent  any  unpleasant 
results. 

A  very  strong  reason  for  the  complete  quiet  which  has  been  insisted 
upon  as  necessary  during  the  first  week  after  confinement  exists  in  the 
fact  that  even  slight  excitement  is  found  frequently  to  increase  to  a 
serious  extent  the  amount  of  discharge,  and  sometimes  even  to  bring  on 
alarming  hemorrhage.  This  seems  especially  to  result  from  any  sudden 
shock  or  fright,  and  great  care  should  be  taken  by  a  nurse  to  avoid  any 


8o 


CONVALESCENCE  FROM  CONFINEMENT. 


risk  of  such  an  occurrence  to  her  patient.  When  any  alarming  increase 
in  the  discharge  is  observed,  the  nurse  should  reassure  the  patient, 
lower  her  head  by  removing  pillows  so  as  to  place  it  on  a  level  with  the 
body,  and  apply  cloths  wrung  out  of  cold  water  to  the  lower  part  of 
the  abdomen — never  failing,  at  the  same  time,  to  send  a  message  to  the 
medical  attendant. 

Even  after  the  discharge  has  become  colorless,  a  return  to  its  orig¬ 
inal  color  may  result  from  excitement  or  from  over-exertion.  When 
this  is  only  temporary,  and  the  quantity  not  much  increased,  impor¬ 
tance  is  not  to  be  attached  to  it ;  but  if  the  return  to  a  red-colored  dis¬ 
charge  continue  for  more  than  a  day,  or  if  the  quantity  be  much 
increased,  the  attention  of  the  doctor  should  be  called  to  its  existence. 
It  will  very  frequently  be  found  that  when  the  patient  is  first  allowed 
to  sit  up  in  bed  to  meals,  a  slight  deepening  of  color  is  observed  in  the 
discharge  ;  no  importance  need  be  attached  to  that  occurrence,  unless 
it  persists  on  each  successive  assumption  of  the  sitting-up  position. 

Douching. — It  has  been  remarked  that  when  proper  cleanliness  is 
preserved,  the  discharge  from  the  vagina  normally  does  not  exhibit  any 
fetor.  It  is  almost  needless  to  say  that  when  a  patient  is  in  charge  of 
an  educated  nurse,  there  ought  never  to  be  any  doubt  that  proper  clean¬ 
liness  is  preserved.  That  is  the  first  duty  of  a  nurse.  In  addition  to 
ordinary  ablutions,  the  mother  should  be  bathed,  at  least  twice  daily, 
with  some  antiseptic  fluid  round  the  entrance  of  the  vagina  ;  and  [if 
any  fetid  or  malodorous  discharge  persists]  the  inside  of  the  vagina 
should  be  syringed  or  douched  twice  a  day  with  a  similar  fluid.  It  is 
in  discharging  this  duty  that  the  nurse  will  find  the  bed-bath  and  the 
douche  described  at  page  66  useful  and  convenient.  Any  antiseptic 
fluid  preferred  by  the  doctor  is  to  be  employed.  The  smooth  and 
padded  end  of  the  bed-bath  is  slipped  underneath  the  hips  of  the 
patient  as  she  lies  on  her  back,  and  if  there  is  a  tube  attached  to  the 
bath  for  the  purpose  of  emptying  it,  this  is  carried  to  a  receptacle 
underneath  the  bed.  The  bag  of  the  douche  is  then  almost  filled  with 
water,  at  a  temperature  of  about  100°  F.,  and  whatever  antiseptic  is 
preferred  is  added  to,  and  mixed  with,  the  water  in  measured  quantity. 
[Carbolic  acid  may  be  employed,  as  advised  on  page  67,  or  one  may 
use  a  soapy  solution  made  from  soap  No.  33  of  the  Sanitary  Bureau 
list  of  toilet  articles,  of  which  a  complete  list  is  given  on  page  1230.]  In 
a  basin  near  at  hand  should  be  an  equal  quantity  or  more  of  warm  water 
rendered  similarly  antiseptic,  with  a  clean  sponge  in  it,  preferably  an 
artificial  one  of  absorbent  cotton-wool  and  gauze.  The  douclie-bag  hav¬ 
ing  been  suspended  from  the  hook  fixed  on  the  wall,  the  nozzle  is  washed 
in  the  basin  of  antiseptic  fluid,  rubbed  over  with  carbolized  vaseline, 
and  introduced  carefully  well  into  the  vagina.  The  stop-cock  is  then 
turned,  and  the  fluid  from  the  douche-can  irrigates  the  vagina,  and  runs 


POSITION  AFTER  CONFINEMENT. 


Si 


out  into  the  bed-bath.  After  the  douching-  is  completed,  the  entrance 
of  the  vagina  and  surrounding  parts  are  sponged  with  the  fluid  in  the 
basin,  and  carefully  dried  with  a  warm,  soft,  clean  towel,  after  which 
the  bed-bath  is  removed. 

When  a  family  syringe  is  employed  in  place  of  a  douche,  it  is  con¬ 
venient  to  use  an  open  hot  water  jug  to  hold  the  antiseptic  fluid.  This 
is  placed  close  to  the  side  of  the  bed  on  a  chair  or  low  table,  and  the 
weighted  end  of  the  syringe  dropped  into  it.  The  nozzle  of  the  syringe 
is  then  washed  in  antiseptic  fluid,  lubricated  with  carbolized  vaseline, 
and  introduced  into  the  vagina,  and  is  held  there  with  one  hand,  while 
the  dilated  part  of  the  syringe  is  alternately  compressed  and  relaxed  by 
the  other  hand.  For  the  purpose  of  vaginal  douching  the  longer  gum- 
elastic  nozzle  is  employed. 

Position  after  Confinement. — For  at  least  some  days  after  con¬ 
finement  it  is  most  important  that  the  mother  maintain  continuously  the 
recumbent  •position,  not  raising  herself  to  the  erect  position  for  any  rea¬ 
son  whatever.  Any  infringement  of  this  rule  is  very  apt  to  be  followed 
by  injury  to  the  womb  and  its  surrounding  tissues.  After  confine¬ 
ment,  the  womb  for  some  weeks  is  heavier  and  larger  than  in  ordinary 
circumstances  ;  and  although  the  ligaments  which  support  it  in  posi¬ 
tion  are  also  strengthened' during  pregnancy  so  as  to  give  efficient  sup¬ 
port,  after  parturition  processes  go  on  which  impair  the  relations  of  the 
womb  to  its  ligaments,  and  render  misplacement  and  chronic  inflam¬ 
matory  troubles  the  frequent  result  of  imprudence  as  regards  position 
during  convalescence. 

For  the  first  few  days,  at  least,  the  patient  must  learn  to  make  use 
of  the  bed-pan  during  micturition,  and  when  the  bowels  are  acted  on. 
The  length  of  time  during  which  the  recumbent  posture  must  be  main¬ 
tained  varies  much  according  to  the  strength  of  the  mother,  and  the 
circumstances  in  which  she  is  situated.  Strong  women,  leading  a  life 
in  the  country  with  plenty  of  outdoor  exercise,  certainly  do  not  require 
to  be  restricted  to  the  same  extent  as  their  more  delicate  sisters  who 
live  in  large  towns.  As  a  rule,  however,  it  may  be  stated  that  no  one, 
however  strong,  should  be  permitted  to  sit  up  in  bed  until  at  least  a 
week  has  elapsed  from  confinement,  while  the  majority  of  women  are 
much  safer  in  remaining  recumbent  for  a  few  days  beyond  that  time. 
There  is  no  doubt  that  many  women,  especially  in  the  poorer  classes  of 
society,  assume  an  erect  posture  frequently  after  only  two  or  three 
days  from  their  confinement ;  but  there  is  equally  little  doubt  that 
much  of  the  chronic  uterine  disease  so  common  among  these  classes  is 
due  to  imprudent  conduct  in  this  respect. 

A  positive  indication  that  sitting  up  in  bed  has  been  indulged  in 
too  soon  is  frequently  found  in  the  existence  of  aching  pain  at  the 
lowTer  part  of  the  back.  If  such  a  pain,  copies  on  within  some  -minute- 


82 


CONVALESCENCE  FROM  CONFINEMENT. 


after  sitting  up,  it  should  be  regarded  as  an  indication  that  the  recum¬ 
bent  position  should  be  again  adopted  for  one  or  two  days  ;  if  it  comes 
on  only  after  remaining  in  the  sitting  position  for  some  time,  it  should 
be  considered  a  warning  signal  not  to  maintain  the  erect  posture  for 
more  than  fifteen  to  thirty  minutes  at  a  time.  Another  indication  of 
risk  in  this  direction  is  found  in  the  occasional  return  of  red-colored 
discharge,  after  it  has  disappeared  for  a  day  or  two.  If  the  change  of 
color  is  very  marked,  the  increase  in  quantity  considerable,  or  if  the 
alteration  persists  for  more  than  a  few  hours,  it  is  wise  again  to  resume 
the  lying-down  position  for  one  or  two  days.  After  sitting  up  to  meals, 
propped  with  pillows,  has  been  permitted  for  a  few  days,  without  any 
sense  of  pain  or  fatigue  being  experienced,  the  patient  may  be  lifted 
out  of  bed  to  a  sofa  or  couch,  and  remain  there  for  a  few  hours  daily. 
It  is  not  judicious  to  try  to  stand  or  walk  until  the  sitting  posture  can 
be  maintained  for  some  hours  without  fatigue  ;  and  care  must  always 
be  exercised  to  guard  against  strain  in  the  first  attempts  to  walk  after 
confinement. 

Normal  Progress  after  Confinement  may,  then,  be  summed  up 
as  consisting  of  one  week  to  ten  days’  recumbency,  one  week  of  sitting 
up  in  bed  for  gradually  lengthening  periods,  one  week  of  rest  on  a 
sofa  or  couch  with  occasional  gentle  efforts  in  walking ;  completed  by 
a  fourth  week  of  gradual  restoration  to  the  ordinary  avocations  of  life. 
This  normal  progress  coincides  with  the  gradual  retrogression  of  the 
enlarged  and  hypertrophied  womb  to  its  usual  condition.  For  the  first 
two  weeks  after  confinement  the  womb  can  be  felt  at  the  lower  part  of 
the  abdomen,  at  first'as  large  as  a  small  cocoanut,  and  gradually,  day  by 
day,  lessening  in  size  and  prominence  ;  by  the  end  of  the  third  week  it 
has  diminished  in  size  so  as  to  become  almost  imperceptible  to  ordinary 
palpation,  while  at  the  end  of  the  fourth  week  frequently  no  indica¬ 
tion  is  afforded  by  the  womb,  as  felt  through  the  walls  of  the  abdomen, 
of  any  increase  whatever  in  its  size.  As  a  matter  of  fact,  the  absolute 
resolution  of  the  womb  to  its  original  size  before  pregnancy  occupies 
generally  six  or  seven  weeks  at  least ;  but  that  recovery  is  practically 
perfect  in  many  cases  after  four  weeks  is  not  unfrequently  indicated  by 
the  commencement  of  another  pregnancy  at  that  period  after  confine¬ 
ment. 

Application  of  the  Binder. — It  is  usual  to  continue  this  to  the 
abdomen  during  the  whole  four  weeks  of  convalescence.  When  prop¬ 
erly  applied,  it  is  of  value  in  giving  support  to  the  over-distended  mus¬ 
cles,  and  tends  to  preserve  the  figure  from  undue  laxity.  It  should  be 
understood,  however,  that  the  function  of  the  binder  is  to  support  the 
lax  abdominal  walls  ;  and  it  should  never  be  employed  for  the  purpose 
of  compressing  the  waist.  Compression  of  the  waist  under  such  cir¬ 
cumstances  must  mean  bulging  out  lower  down,  and  may  lead  to  dis- 


THE  HAIR  AND  SKIN  CHANGES. 


83 

placement  of  the  womb.  Rather  should  the  binder  be  employed  for 
the  purpose  of  supporting  and  lifting  upward  the  lower  part  of  the 
abdomen,  so  as  to  remove  superincumbent  weight  from  the  already 
overweighted  womb  ;  and,  with  this  object  in  view,  it  should  always 
be  drawn  more  tightly  together  at  its  lower  than  at  its  upper  edge.  A 
binder  is  intended  for  support,  not  for  compression,  and  it  is  only  when 
used  for  this  purpose  that  its  employment  is  beneficial.  When  the 
mother  begins  to  follow  her  usual  occupations,  it  may  conveniently  be 
replaced  by  a  belt,  such  as  has  been  described  as  useful  in  the  early 
stage  of  pregnancy  ;  and  many  women  will  find  that  the  tone  of  the 
abdominal  muscles  is  improved  and  the  figure  regained  by  wearing  such 
a  belt  for  two  or  three  months  after  confinement. 

Mothers  must  make  up  their  minds  to  tolerate  the  fact  that  their 
waists  will  probably  measure  some  few  inches  more  on  recovery  from 
confinement  than  they  did  before  the  days  of  pregnancy.  The  true  dis¬ 
tinction  between  the  figure  of  the  matron  and  that  of  the  maiden  is 
found  in  the  fuller  bust  and  wider  waist,  resulting  as  a  consequence  of 
childbirth  ;  and  when  the  two  are  found  together,  they  form  a  harmo¬ 
nious  combination,  natural  and  artistic.  It  is  sad  that  so  many  women 
are  blind  to  this  fact,  and  produce  an  incongruous  result  by  compressing 
the  waist,  and  causing  bulging  of  the  lower  part  of  the  abdomen. 

The  Hair  and  Skin. — In  the  later  months  of  pregnancy  it  will 
generally  be  noticed  that  the  hair  becomes  somewhat  more  coarse  in 
quality,  while  at  the  same  time  the  skin  tends  to  become  a  little  rough¬ 
ened.  During  the  first  few  weeks  after  confinement  women  usually 
desquamate  to  some  extent,  and  at  the  same  time  lose  some  of  the  hair 
of  the  head,  which  is  replaced  by  hair  of  a  finer  texture,  but  generally 
of  rather  darker  color. 

The  desquamation  of  the  skin  may  be  so  slight  and  gradual  as  to 
escape  notice,  unless  attention  is  specially  directed  to  it ;  but  some¬ 
times  it  is  quite  obvious,  the  surface  of  the  skin  coming  off  in  distinct 
small  scales,  such  as  are  noticed  after  measles  and  some  other  febrile 
diseases.  At  the  same  time,  there  is  a  tendency  to  lose  any  teeth  which 
may  not  be  quite  healthy  ;  and  occasionally  even  teeth  apparently  quite 
healthy  loosen  and  fall  out  after  parturition.  In  view  of  the  possibility 
of  this,  it  is  judicious  for  expectant  mothers  to  have  their  teeth  exam¬ 
ined  by  a  dentist  in  the  early  months  of  pregnancy,  so  that  any  incip¬ 
ient  disease  may  be  arrested,  and  the  teeth  prepared  to  resist  as  far  as 
possible  any  prejudicial  influence. 

The  deepening  of  color  of  the  hair  after  confinement  is  somewhat  in¬ 
explicable  ;  but  the  same  phenomenon  is  observed  usually  when  the 
hair  has  been  temporarily  lost  from  any  other  cause,  and  the  growth 
subsequently  renewed.  The  color  darkens  more  and  more  with  each 
successive  confinement, 


84 


CONVALESCENCE  FROM  CONFINEMENT. 


Drawbacks  to  Rapid  Convalescence.— While  convalescence 
after  confinement  usually  progresses  in  the  satisfactory  and  pleasant 
manner  already  described,  there  are  occasional  drawbacks. 

Reference  has  been  already  made  to  the  occasional  occurrence  of 
marked  fetor  in  the  vaginal  discharge.  When  this  exists,  and  some¬ 
times  even  before  its  presence  becomes  apparent,  the  mother  sometimes 
is  attacked  with  feverishness,  manifesting  itself  generally  first  by  sen¬ 
sations  of  cold,  accompanied  or  followed  occasionally  by  distinct  shiv¬ 
ering  and  chattering  of  the  teeth  ;  and  afterwards  by  a  sense  of  dry 
heat  and  discomfort  following  the  sensations  of  cold.  There  may  be 
distinct  headache,  and  a  general  sense  of  uneasiness  usually  exists  along 
with  the  sensation  of  increased  heat.  The  initiative  shivering  of  fever 
is  to  be  distinguished  from  the  nervous  shivering  described  above  as 
occasionally  following  parturition,  by  its  late  appearance,  perhaps  two 
or  three  days  after  confinement,  by  the  distinct  sensation  of  cold  expe¬ 
rienced,  by  the  presence  of  headache,  and  by  the  succeeding  feverish¬ 
ness.  Its  occurrence  should  always  be  considered  a  reason  for  sending 
at  once  for  the  medical  attendant,  as  early  treatment  is  most  important. 

Susceptibility  to  Infection. — During  convalescence  from  confine¬ 
ment  women  are  particularly  susceptible  to  the  infection  of  various  con¬ 
tagious  diseases,  such  as  measles,  scarlet  fever,  small-pox,  etc. ;  and  great 
care  should  always  be  taken  that  any  possible  source  of  infection,  direct 
or  indirect,  is  carefully  excluded  from  the  house.  It  is  not  sufficiently 
recognized  that  infection  can  very  easily  be  conveyed  in  letters  ;  and  it 
is  judicious  to  arrange  that  all  letters  addressed  to  women  convalescing 
from  confinement  should  be  opened  and  read  by  some  one  else  before 
being  given  to  the  convalescent  patient.  It  is  a  serious  shock  to  a 
medical  attendant  to  be  told  by  his  patient  that  she  has  just  received  a 
letter  from  a  female  friend  apologizing  for  her  inability  to  visit  her,  in 
consequence  of  being  detained  at  home  nursing  her  children  in  scarlet 
fever  or  measles.  And  such  experiences  are  not  unfrequent. 

Helps  to  Convalescence. — In  conclusion  it  may  be  added  that 
the  best  safeguards  for  insuring  satisfactory  convalescence  are  cleanli¬ 
ness,  fresh  air,  and  as  much  sunshine  as  can  be  obtained.  The  two  first 
are  at  the  command  of  every  one.  There  is  no  greater  risk  of  taking 
cold  after  confinement  than  at  any  other  time,  and  the  more  and  the 
further  windows  can  be  opened  to  admit  external  air,  the  more  satis¬ 
factory  will  be  the  progress  of  the  invalid.  Temperature  of  course  will 
have  to  be  regulated  ;  and  when  the  external  air  is  too  cold  to  admit  of 
continuously  open  windows,  a  good  fire  in  a  bedroom  is  an  admirable 
aid  to  ventilation  ;  but  even  in  cold  weather  it  is  wise,  for  a  few  min-' 
utes  at  a  time,  twice  or  thrice  a  day  to  have  the  window  of  the  bed¬ 
room  opened  widely,  care  being  taken  that  the  mother  and  baby  are  at 
the  time  properly  covered  with  blankets, 


NURSING. 


CHAPTER  X. 


The  Mother  in  Relation  to  the  Infant. 

t, 

Duty  of  Mother  to  Suckle  Infant;  Occasional  Exceptions;  Normal  Secretion 
of  Milk;  Importance  of  Commencing  Suckling  soon  after  Confinement;  Pro¬ 
cess  of  Sucking;  Flatness  of  Nipple;  Management;  Breast-Pump;  Employ¬ 
ment  of  Older  Baby:  Soreness  of  Nipple;  Fissures  of  Nipple;  Fulness  of 
Breasts;  Insufficient  Flow  of  Milk;  Methods  of  Increasing  Flow;  Frequency 
of  Suckling;  Indications  of  Discomfort  of  Baby;  Probable  Meaning;  Ten¬ 
dency  to  Painful  Digestion;  Susceptibility  of  Infant  to  Improper  Diet  and 
Drugs  taken  by  Mother;  Tension  of  Breasts;  Localized  Hardness  and 
Swelling;  Abscess  of  Breast;  Relation  to  Fissures;  Importance  of  Cleanli¬ 
ness;  Objects  of  Treatment;  Question  of  giving  up  Nursing;  Normal  Duia- 
tionof  Nursing;  Indications  pointing  to  Propriety  of  Cessation;  Symptoms 
due  to  Over-nursing— Relief  of  Symptoms;  Arrest  of  Secretion  of  Milk; 
General  Treatment;  Local  Applications. 

With  most  mothers  a  considerable  portion  of  the  period  of  conva¬ 
lescence  from  confinement  is  occupied,  and  most  agreeably  occupied,  in 
administering  to  the  nutrition  of  the  new-born  infant ;  and  the  remark 
may  reasonably  be  made  that  information  with  reference  to  the  func¬ 
tion  of  lactation  should  have  appeared  in  the  previous  chapter.  The 
importance  of  the  subject,  however,  it  may  be  urged,  claims  a  separate 
chapter  for  itself ;  and  as  the  adaptation  of  the  breasts  for  this  func¬ 
tion  commences  some  time  before  confinement,  while  their  utilization 
for  the  nourishment  of  the  infant  usually  continues  for  many  months 
after  complete  convalescence,  the  propriety  and  convenience  of  a  dis¬ 
tinct  chapter  relating  to  lactation  seem  fully  justified. 

As  a  general  rule,  it  may  be  said  that  it  is  the  duty  of  every  mother 
who  can  do  so  to  suckle  her  own  infant.  It  is  a  duty  which  she  tacitly 
accepts  when  she  undertakes  the  other  responsibilities  inherent  to  mar¬ 
ried  life,  and  on  its  proper  fulfilment  may  depend  largely  the  future 
health  of  her  child. 

Exceptions:  Constitutional  Obstacles. — To  this  general  rule 
there  are  some  exceptions,  involving  considerations  relative  respectively 
to  the  health  of  the  mother  and  of  the  child. 

There  are  some  conditions  of  health  in  the  mother  which  may  ren¬ 
der  it  injurious  for  her  to  undertake  the  fatigue  and  strain  of  nursing 

her  baby.  The  propriety  of  refraining  from  nursing  will  generally  be 

85  . 


86  THE  MOTHER  IN  RELATION  TO  THE  INFANT. 


indicated  by  the  medical  attendant ;  but  it  may  be  stated  that  the 
existence  of  any  chronic  disease  affecting  the  general  health,  and  more 
especially  the  presence  of  any  tendency  to  consumption,  renders  nur¬ 
sing  distinctly  prejudicial  to  the  mother. 

In  the  interest  of  the  infant,  also,  it  may  be  desirable  sometimes  to 
abstain  from  nursing.  There  is  no  doubt  that  children  inherit  constitu¬ 
tional  taints,  such  as  predispositions  to  scrofula,  rickets,  or  consumption 
from  their  parents  ;  and  there  is  strong  evidence  that  these  hereditary 
peculiarities,  when  inherited  from  the  mother,  are  increased  in  intensity 
if  the  infant  is  nourished  by  its  mother’s  milk  during  the  early  months 
of  life.  In  cases,  then,  where  the  mother  suffers  from  any  marked 
constitutional  taint  of  this  character,  it  is  proper  for  her  to  sacrifice,  in 
the  interests  of  the  child,  the  pleasure  she  might  enjoy  from  nursing  it ; 
and  to  submit  to  the  alternative  of  employing  a  wet-nurse,  or  by  having 
the  infant  brought  up  by  hand,  according  to  the  advice  of  her  doctor. 

Insufficient  Secretion  of  Hilk. — Again,  a  considerable  number 
of  mothers  are  physically  unable  to  nurse  their  infants  on  account  of 
the  secretion  of  milk  being  altogether  wanting,  or  so  deficient  in  quan¬ 
tity  as  to  be  insufficient  for  the  due  nourishment  of  the  child.  This 
deficiency  does  not  seem  invariably  to  depend  upon  the  condition  of 
the  general  health,  for  it  is  not  unfrequently  observed  in  mothers 
apparently  perfectly  healthy  in  other  respects.  Conditions  of  life  seem 
to  have  some  influence  in  the  matter,  for  it  appears  undoubted  that  this 
incapacity  for  nursing  is  noticed  more  frequently  among  the  richer 
classes,  and  among  those  living  in  towns,  than  among  the  poorer 
classes,  and  those  whose  residence  is  mainly  in  the  coun'  ry. 

Inability  on  the  Part  of  the  Infant. — Sometimes  also  an  infant 
will  exhibit  a  dislike  to  being  nourished  by  its  mother,  and  will  refuse 
to  suck  the  breast  properly.  In  some  cases,  this  will  be  for.nd  tr  be 
due  to  a  difficulty  arising  from  the  shape  of  the  mother’s  nipple  *  but 
in  other  cases,  apparently,  the  dislike  arises  from  some  peculiar  quality 
of  the  milk,  which  is  distasteful  to  the  child.  When  a  child  refuses  to 
suck  the  breast,  it  is,  of  course,  always  necessary  to  be  certain  that  it  is 
not  incapacitated  from  doing  so  by  any  malformation  of  the  mouth  or 
nose 

Development  of  Lacteal  Secretion. — From  a  very  early  period 
of  pregnancy  some  enlargement  of  the  breasts  is  generally  observable, 
as  has  been  pointed  out  in  Chapter  III. ;  and  not  unfrequently  the  en¬ 
largement  is  accompanied  by  an  occasional  slight  watery  discharge 
from  the  nipple.  More  exceptionally,  the  discharge  is  of  a  distinctly 
milky  character.  From  one  to*tliree  days  after  confinement  the  breasts 
usually  become  very  full  and  tense,  the  tension  sometimes  being  so 
great  as  to  give  rise  to  considerable  discomfort.  At  the  same  time, 
often  some  degree  of  headache  is  experienced,  and  the  temperature  of 


CONCERNING  SUCKLING  OR  NURSING.  8; 

the  body  may  be  somewhat  raised,  while  sensations  of  thirst,  due  to 
the  slight  fever,  are  complained  of.  These  symptoms,  which  are  caused 
by  the  physiological  excitement  of  the  breast  associated  with  the  rapid 
secretion  of  milk,  are  relieved  when  the  infant  succeeds  in  partially 
exhausting  the  breasts  by  sucking ;  and  frequently  the  relief  is  in¬ 
creased  by  an  almost  continuous  slight  flow  of  milk  from  the  breasts 
during  the  intervals  of  nursing. 

It  is  always  very  desirable  that  the  infant  should  be  induced  to 
suck  the  breast  regularly  at  intervals  before  this  tension  and  fulness 
manifests  itself.  It  is  proper  to  place  the  child  to  the  breast  as  soon 
after  its  birth  as  its  mother  is  able  to  receive  it,  and  to  repeat  the  pro¬ 
cess  every  two  or  three  hours,  as  it*is  found  that  the  stimulus  of  the 
baby’s  sucking  induces  the  breasts  of  the  mother  to  fulfil  their  function 
in  secreting  milk.  Another  reason  for  so  doing  is  found  in  the  fre¬ 
quently  undeveloped  condition  of  the  nipple  in  women  who  are  nursing 
a  child  for  the  first  time.  Often  the  nipple  does  not  project  at  all  from 
the  surface  of  the  breast,  and  the  child  has  much  difficulty  in  obtain¬ 
ing  any  hold  upon  it.  Immediately  after  the  confinement,  the  breasts 
are  usually  somewhat  lax,  and  during  that  period  it  is  much  more  easy 
for  the  child  to  draw  out  the  nipple  than  it  would  be  if  its  efforts  were 
commenced  only  when  the  breasts  are  tense  and  full. 

The  Process  of  Sucking  is  mainly,  but  not  altogether,  a  mechan¬ 
ical  one.  The  infant  seizes  the  nipple  of  the  mother  between  its 
tongue  and  the  roof  of  its  mouth,  and  causes  a  temporary  partial 
vacuum  by  drawing  in  its  breath  ;  at  the  same  time,  it  presses  upon 
the  base  of  the  nipple  with  its  gums  and  its  lips.  The  suction 
acts  in  the  same  manner  as  an  exhausting  pump  upon  the  small  tubes 
in  the  mother’s  breast  which  contain  the  milk  ;  the  milk  being  pushed 
by  the  compression  of  the  external  air  toward  and  into  the  mouth  of 
the  child.  This  is  the  purely  mechanical  part  of  the  action  ;  but  in 
addition  there  is  assistance  from  physiological  muscular  action.  The 
tubes  containing  the  milk  in  the  breasts  have  muscular  fibres  in  their 
walls  which  contract  and  press  out  the  milk  when  stimulated  by  the 
sucking  action  of  the  child’s  mouth,  and  these  contractions  have  some¬ 
times  so  much  effect  that  the  milk  is  actually  squirted  into  the  infant’s 
mouth  more  rapidly  than  it  is  able  to  swallow  it.  This  reflex  influence, 
as  it  is  called,  on  the  milk-tubes  not  unfrequently  affects  not  only  the 
breast  the  child  is  sucking,  but  also  the  other  one,  so  that  it  is  not  un¬ 
common  to  observe  a  discharge  of  milk  from  one  breast,  while  the 
child  is  exhausting  the  other. 

Depression  of  the  Nipple. — When  the  nipple  is  so  flat  or  de¬ 
pressed  that  the  efforts  of  the  child  to  seize  it  are  ineffectual,  some 
means  must  be  resorted  to  to  draw  it  out,  and  thus  second  the  efforts  of 
the  infant  to  obtain  nourishment.  The  best  method  of  doing  this  is  by 


88  THE  MOTHER  IN  RELATION  TO  THE  INFANT. 

the  use  for  a  few  days  of  an  artificial  nipple  fitted  on  to  a  glass  shield, 
which,  when  slightly  lubricated  with  vaseline  round  the  edge,  will 
adhere  to  the  breast  around  the  nipple,  and  permit  of  strong  suction  by 
the  child.  The  nipple  should  be  attached  to  the  glass  without  any 
intervening  india-rubber  tubing,  which  when  used  is  exceedingly  diffi¬ 
cult  to  keep  clean. 

When,  even  with  the  assistance  of  this  nipple  and  shield,  the  infant 
is  unable  to  draw  milk  from  the  breast,  either  the  nurse  or  the  mother 
must  herself  draw  out  the  nipple  with  the  aid  of  an  exhausting  breast- 
glass.  The  most  convenient  apparatus  for  this  purpose  consists  of  a 

glass  nipple-shield  forming  part  of 
a  small  glass  reservoir,  to  the  upper 
end  of  which  a  piece  of  india-rubber 
tubing  is  attached,  long  enough  to 
reach  to  the  mouth  of  the  mother 
when  the  shield  is  placed  upon  the 
breast  over  the  nipple.  When  the 
mother  or  nurse  exhausts  the  air  in 
the  reservoir  by  means  of  the  tube, 
the  nipple  is  drawn  into  the  shield, 
and  the  milk  drawn  from  the  breast 
runs  down  into  the  deeper  part  of 
the  reservoir.  When  some  quantity 
of  milk  has  been  obtained  in  this 
way,  it  may  be  given  to  the  baby 
either  by  transferring  it  to  a  bottle, 
or  more  simply,  by  replacing  the 
india-rubber  tubing  with  an  india- 
rubber  artificial  nipple,  through 
which  the  infant  may  suck  the 
milk.  It  is  well  always  immediately 
after  drawing  out  the  nipple  by  either  of  the  means  described  above 
to  apply  the  baby  to  the  drawn-out  nipple,  and  induce  it  to  suck,  so  as 
to  maintain  and  increase  the  improvement  obtained.  Sometimes,  by 
pressing  gently  on  the  breast  toward  the  nipple,  the  mother  or  nurse 
may  induce  greater  exertion  on  the  part  of  the  baby  by  giving  it  the 
stimulus  of  feeling  the  flow  of  milk.  Even  at  the  very  early  age  of  one 
day,  infants  often  show  considerable  signs  of  irritation  when,  with  all 
their  efforts,  they  fail  to  obtain  any  reward  in  the  form  of  milk  ;  and 
some  patience  and  coaxing  may  be  required  to  induce  the  infant  to 
fulfil  its  share  of  the  act  of  obtaining  nourishment.  Patience  and  time 
are  well  spent  in  obtaining  the  end  sought,  for  the  nourishment  of  the 
child  never  proceeds  so  satisfactorily  when  the  use  of  artificial  nipples 
has  to  be  resorted  to  for  any  length  of  time. 


Fig.  15. 


EXHAUSTING  BREAST-GLASS. 


TENDERNESS  OF  THE  NIPPLE. 


89 

%  If  the  artificial  nipple  and  the  breast  exhauster  have  both  been 
inefficacious  in  improving  the  condition  of  the  nipple,  an  older  baby, 
when  available,  may  be  utilized  to  exhaust  the  breasts,  and  will  occa¬ 
sionally  succeed  in  drawing  out  the  nipple  after  artificial  means  have 
failed  to  effect  an  improvement. 

Tenderness  of  the  Nipple. — The  early  efforts  of  the  infant  to 
seize  the  nipple  often  result  in  some  pain  and  discomfort  to  the  mother, 
and  not  unfrequently  the  tender  skin  covering  the  nipple  becomes  some¬ 
what  raw  and  sore.  For  the  purpose  of  obviating  this,  some  women, 
for  two  or  three  weeks  before  confinement,  attempt  to  strengthen 
and  harden  the  skin  of  the  nipple  by  bathing  it  two  or  three  times  a 
day  with  whiskey  or  brandy  or  eau-de-Cologne  somewhat  diluted  with 
water.  It  is  doubtful  if  this  method  of  preparation  for  nursing  is  of 
much  value  ;  and  sometimes  it  is  positively  injurious,  making  the  skin 
so  hard  that  it  cracks,  and  presents  tender  fissures  when  drawn  out  and 
pressed  on  by  the  mouth  of  the  baby.  On  the  whole,  it  is  best  to  leave 
the  breasts  untouched  until  after  confinement,  and  when  suckling  is 
commenced  to  be  very  careful  always  to  bathe  and  afterward  dry  the 
nipples  thoroughly  with  a  clean  handkerchief  or  soft  towel  immediately 
after  the  infant  has  ceased  nursing.  If  any  rawness  or  soreness  is  pres¬ 
ent,  a  simple  salve  such  as  cold  cream  [or  the  Magnetic  Ointment,  see 
page  1228]  may  be  applied  after  the  nipple  has  been  carefully  dried. 
Any  salve  thus  used  must  be  removed  by  sponging  before  the  child  is 
again  allowed  to  take  the  breast. 

When  fissures  of  some  depth  are  caused  in  the  nipple  by  suck 
ling,  it  may  be  necessary  for  two  or  three  days  to  resort  to  a  glass 
shield  during  nursing,  so  as  to  give  the  fissure  time  to  heal.  The  appli¬ 
cation  of  one  or  two  coats  of  flexible  collodion  over  the  fissure  assists 
much  in  giving  the  rest  necessary  to  effect  a  cure.  Fissures  of  this 
kind  often  bleed  to  some  extent  when  the  child  is  suckling,  and  when 
the  blood  is  noticed  on  the  mouth  of  the  infant,  it  may  lead  to  an  erron¬ 
eous  impression  that  it  is  due  to  some  disease  of  the  child.  Occasionally 
the  baby  will  swallow  some  of  the  blood  ;  and  if  it  becomes  sick 
afterward,  the  vomited  blood  may  excite  much  alarm.  An  examina¬ 
tion  of  the'  breast  and  the  detection  of  the  fissure  will  explain  the  occur¬ 
rence  and  reassure  the  anxious  mother. 

When  the  secretion  of  milk  after  confinement  is  at  the  commence¬ 
ment  characterized  by  much  fulness,  tension,  and  discomfort  of  the 
breasts,  relief  will  generally  be  afforded  by  the  employment  of  some 
laxative  medicine.  The  most  eligible  for  this  purpose  is  compound 
licorice  powder  or  castor-oil.  Saline  purgatives,  otherwise  very  useful 
in  relieving  tension  of  this  kind,  are  ineligible  on  account  of  the  fact 
that  they  generally  act  severely  on  the  infant  as  well  as  the  mother, 
being  conveyed  to  the  infant  bv  means  of  the  milk.  At  the  same  time, 


go 


THE  MOTHER  IN  RELATION  TO  THE  INFANT. 


the  mother  should  somewhat  restrict  her  diet,  abstaining  for  a  day  or 
two  from  much  meat,  and  from  all  stimulants,  and  limiting  the  amount 
of  fluid  nourishment.  Relief  will  be  obtained  also  by  having  the 
breasts  gently  rubbed  two  or  three  times  a  day  with  olive-oil  [or  Mag¬ 
netic  Ointment],  the  rubbing  being  directed  from  the  base  toward  the 
nipple.  In  the  intervals  of  rubbing,  a  cool  lotion  made  of  equal  parts 
of  eau-de-Cologne  or  rectified  spirit  and  water  may  be  kept  applied 
over  the  breasts  on  a  folded  handkerchief  or  piece  of  lint.  When  the 
flow  of  milk  from  the  breasts  in  the  intervals  of  nursing  continues  to 
such  an  extent  as  to  render  the  clothing  wet  and,  uncomfortable,  the 
application  of  some  absorbent  wool  tissue  will  absorb  the  superfluous 
milk,  and  conduce  to  the  comfort  of  the  mother.  The  wool  tissue  must 
be  changed  as  often  as  necessary. 

Insufficiency  of  flilk  . — Sometimes  the  amount  of  milk  secreted 
by  the  breasts  will  be  found  to  be  insufficient  for  the  wants  of  the 
infant.  Instead  of  becoming  very  full  and  discharging  some  milk 
from  the  nipple,  the  breasts  will  remain  more  or  less  flaccid,  and  when 
pressure  is  made  upon  them  only  a  little  watery  fluid  exudes.  In  such 
cases  some  efforts  should  be  made  to  increase  the  flow  of  milk  before 
sucklmg  is  given  up  as  being  hopeless.  Increased  richness  of  diet,  and 
the  drinking  of  considerable  quantities  of  milk,  will  often  afford  ma¬ 
terial  improvement  in  the  quantity  and  quality  of  the  milk  secreted. 
Some  drugs  seem  to  have  a  beneficial  action  in  this  respect,  and  will 
occasionally  be  prescribed  by  the  doctor  in  attendance.  It  should  never 
be  forgotten  that  the  most  powerful  stimulus  to  the  secretion  of  the 
breast  is  afforded  by  the  sucking  of  the  child  ;  and  even  where  milk  is 
small  in  quantity,  the  child  should  be  put  to  the  breast  at  regular  inter¬ 
vals,  any  deficiency  being  supplemented  by  artificial  means  only  after 
both  breasts  have  been  exhausted  by  the  infant. 

Frequency  in  Suckling.— The  frequency  with  which  an  infant 
should  be  nursed  by  its  mother  will  vary  somewhat  with  the  quantity 
and  quality  of  the  milk,  and  with  the  robustness  and  appetite  of  the 
child.  Generally  speaking,  for  the  first  month  or  two  of  life,  an  infant 
requires  to  be  nursed  at  least  once  every  two  hours  during  the  daytime, 
and  once  every  three  or  four  hours  during  the  night.  If  the  secretion 
of  milk  is  abundant,  the  intervals  may  be  lengthened  a  little  ;  while, 
even  if  the  quantity  is  not  very  great,  it  is  seldom  desirable  to  nurse 
more  frequently  than  every  hour  and  a  half.  When  the  child  is  five  or 
six  weeks  old,  efforts  should  be  made  to  lengthen  the  intervals  of  nur¬ 
sing  during  the  night ;  often  at  the  end  of  two  months  an  interval  of 
five  hours  can  be  obtained  during  the  night,  which  is  a  very  great  boon 
to  the  mother.  When  the  child  has  attained  three  months,  the  inter¬ 
vals  during  the  day  can  often  be  increased  to  three  hours,  while  at 
night  the  child  will  frequently  sleep  five  or  six  hours  without  requiring 


INFANTILE  INDIGESTION. 


9* 


the  breast ;  and  those  intervals  will  usually  be  maintained  until  the 
child  is  weaned.  Exceptionally,  in  the  later  months  of  nursing,  some 
children  will  sleep  throughout  the  whole  night  without  requiring  to  be 
fed,  but  this  is  unusual ;  and  a  mother  may  consider  herself  fortunate 
if,  after  nursing  her  child  when  she  goes  to  bed  about  ten  o’clock,  she 
is  able  regularly  to  enjoy  unbroken  rest  until  four  or  five  o’clock  in  the 
morning.  If  the  infant  at  that  time  demands  food,  it  will  usually  go 
to  sleep  again  afterward,  and  a  further  rest  may  be  obtaiued  until 
eight  or  nine. 

Signs  of  Indigestion. — If  an  infant  is  healthy,  and  the  milk  of 
the  mother  satisfactory,  it  is  usually  perfectly  quiet  and  comfortable 
immediately  after  nursing,  and  in  its  earlier  days  generally  inclined  for 
sleep. 

If,  however,  it  is  restless,  obviously  uncomfortable,  and  inclined  to 
cry,  it  may  be  concluded  that  either  the  digestion  of  the  infant  or  the 
quality  of  the  milk  of  the  mother  is  at  fault.  Very  frequently  the 
cause  of  the  discomfort  is  found  in  the  stomach  of  the  child  being 
overloaded  with  milk,  and  distended  to  such  an  extent  as  to  interfere 
with  digestion. 

When  the  supply  of  milk  is  generous,  many  infants  habitually 
ingest  more  than  they  are  able  to  accommodate  or  digest.  Usually, 
after  a  few  miuutes,  relief  is  afforded  by  vomiting,  and  the  superfluous 
contents  of  the  stomach  being  thus  disposed  of,  the  infant  settles 
down  in  comfort  to  digest  what  remains.  In  infants  the  act  of  vomit¬ 
ing  seems  to  be  painless  and  not  unpleasant ;  and,  unlike  what  occurs 
in  older  people,  only  the  superfluous  amount,  not  the  whole  contents  of 
the  stomach,  is  evacuated  by  the  process.  Many  infants  are  in  this  way 
habitually  sick  after  nursing,  and  yet  make  most  satisfactory  progress, 
and  continue  in  perfect  health.  It  is  possible,  of  course,  when  an 
infant  overloads  its  stomach  in  this  manner,  to  withdraw  it  from  the 
breast  before  it  has  reached  the  point  of  satiety  ;  but  the  infant  usually 
resents  this,  and  shows  its  resentment  by  loud  crying.  A  rather  more 
satisfactory  manner  of  dealing  with  the  difficulty  is  found  in  partially 
exhausting  the  breast  with  a  breast-pump  before  allowing  the  baby  to 
nurse  ;  it  will  then  usually  be  tired  of  sucking  before  it  has  been  able 
to  extract  sufficient  milk  to  overload  its  stomach.  Rather  more  effort 
on  the  part  of  the  child  is  required  to  obtain  milk  as  the  breast  becomes 
gradually  exhausted  ;  and  the  infant  seems  to  cease  sucking  when  the 
effort  appears  out  of  proportion  to  the  result  obtained.  When  hungry, 
a  baby  will  exert  itself  strongly  to  obtain  milk  from  a  breast  compara¬ 
tively  empty,  while,  when  partially  satiated,  it  will  scarcely  suck  at  all 
even  a  breast  moderately  full. 

As  a  rule,  only  one  breast  should  be  employed  for  each  meal  of 
the  child,  the  breasts  being  alternately  used.  By  this  means  it  is  much 


92 


THE  MOTHER  IN  RELATION  TO  THE  INFANT. 


more  easy  to  prevent  the  nipples  suffering  from  injury  ;  and  the  baby 
is  usually  satisfied  at  less  cost  to  the  mother.  It  is  found  that  the  milk 
first  discharged  from  the  breast  is  somewhat  richer  in  quality  than  that 
secreted  later.  In  exhausting  fully  one  breast  at  a  meal,  the  infant  gets 
first  the  richer  milk  with  slight  exertion,  then  milk  of  a  poorer  quality 
with  somewhat  greater  exertion  ;  and  the  temptation  which  presents 
itself  to  take  too  much  is  lessened.  If,  on  the  other  hand,  the  baby  is 
taken  away  from  one  breast  before  it  is  exhausted,  and  presented  to 
the  other,  it  again  gets  the  richer  milk  with  comparatively  slight 
trouble,  and  is  very  apt  to  take  more  than  its  stomach  can  properly 
accommodate. 

Circumstances  of  course  may  present  themselves  where  it  is  desir¬ 
able  to  utilize  this  difference  in  the  secretion  and  discharge  of  the  milk. 
Thus,  if  an  infant  is  not  very  strong,  and  easily  gets  tired  when  nur¬ 
sing,  it  may  be  desirable  to  remove  it  from  one  breast  before  it  has  ex¬ 
hausted  it,  and  place  it  to  the  other,  so  that  it  may  have  a  larger  and 
richer  meal  without  much  fatigue  or  exertion. 

If  the  secretion  of  milk  is  not  very  copious,  and  the  infant  strong 
and  robust,  even  from  very  early  days  it  may  demand  the  contents  of 
both  breasts  at  one  meal ;  and  probably  the  majority  of  nursing  moth¬ 
ers  find  that  after  four  or  five  months  of  nursing  the  contents  of  both 
breasts  are  not  too  much  for  the  capacity  of  the  child.  At  that  time 
from  birth,  however,  the  intervals  of  nursing  will  usually  have  length¬ 
ened  considerably,  so  that  the  exhaustion  of  both  breasts  will  not  be 
such  a  tax  upon  the  strength  of  the  mother  as  it  would  have  been  in 
the  earlier  days  of  maternity. 

There  can  be  little  doubt  that  some  children  are  born  with  a  ten¬ 
dency  to  painful  digestion.  Cases  are  met  with  where  no  apparent  fault 
can  be  found  with  the  milk,  and  where  the  evidence  of  marked  growth 
and  progress  indicate  the  satisfactory  nourishment  of  the  child  ;  and 
yet  where  every  act  of  nursing  is  followed  by  some  discomfort  and 
pain.  Careful  examination  of  the  excretions  of  the  child  will  in  such 
cases  give  no  indication  of  imperfect  digestion,  and  when  indiscretion 
in  diet  on  the  part  of  the  mother  has  been  excluded,  the  existence  of 
exceptional  irritability  of  the  stomach  must  be  suspected.  Before 
accepting  this  as  an  explanation,  however,  one  should  be  fully  satisfied 
that  no  other  possible  source  of  discomfort  is  present.  The  possibility 
of  over-richness  of  the  milk  and  of  over-filling  of  the  stomach  should 
be  kept  in  view  ;  and  the  excretions  of  the  bowels  and  kidneys  should 
be  examined  frequently  so  that  assurance  is  felt  at  to  their  perfectly 
healthy  condition.  Many  cases  of  apparent  iiritability  of  digestion  will 
be  found  to  be  caused  and  maintained  by  some  error  or  peculiarity  of 
diet  on  the  part  of  the  mother.  The  stomach  of  the  most  healthy 
infant  is  a  very  sensitive  organ,  and  will  often  resent  the  intrusion 


DISCOMFORTS  OF  THE  BREAST. 


93 


or  milk  affected  in  character  by  articles  of  diet  which  have  not  caused 
any  discomfort  to  the  mother.  Mention  has  been  made  of  the  facility 
with  which  saline  medicines  taken  by  the  mother  are  absorbed  by  the 
infant  through  the  breasts.  In  like  manner  infants  are  found  some¬ 
times  to  be  affected  by  raw  fruits,  such  as  strawberries  or  cherries, 
eaten  by  the  mother,  or  by  acid  fluids,  such  as  sherry  wine,  or  vinegar 
used  in  dressing  salads,  or  in  sauces.  In  all  cases  where  irritability  of 
digestion  is  present,  thorough  inquiry  should  be  made  into  the  diet  of 
the  mother,  and  experiment  should  be  made  as  to  the  effect  of  absti¬ 
nence  for  some  days  from  any  article  of  diet  of  doubtful  propriety. 
When  the  mother  herself  is  conscious  of  discomfort  in  digesting  any 
special  food,  no  doubt  can  exist  as  to  its  prejudicial  influence  on  the 
child  ;  and  no  true  mother  will  hesitate  to  abstain  from  any  article  of 
diet  when  she  knows  that  by  doing  so  she  can  shield  her  infant  from 
discomfort  and  pain. 

Discomforts  of  the  Breast.— When  the  breasts  are  full  of 
milk,  they  will  often  be  remarked  to  be  somewhat  tense  and  lumpy, 
and  there  may  exist  a  general  feeling  of  tenderness  on  pressure  upon 
them.  The  tension  and  tenderness  will  be  found  to  disappear,  as  a 
rule,  entirely  when  the  breasts  have  been  exhausted  by  the  infant. 
Sometimes  it  may  be  observed  that  at  some  limited  spot  in  the  breast  a 
•  feeling  of  hardness  remains,  or  it  may  be  that  an  actual  small  swelling 
may  be  perceived,  which  remains  somewhat  tender  to  touch.  This 
swelling  is  usually  the  result  of  some  impediment  to  the  escape  of  milk 
from  this  particular  part  of  the  breast.  The  attention  of  the  doctor 
and  the  nurse  should  be  called  to  any  abnormality  of  this  kind,  as  there 
is  a  risk  that  if  attention  is  not  given  to  it,  it  may  eventuate  in  abscess. 
If  the  tenderness  is  marked,  or  if  the  breast  feels  at  all  weighty,  care 
should  be  taken  to  avoid  injury  by  supporting  the  breast  either  on  a 
pad  inside  the  corset,  or  by  means  of  a  handkerchief  tied  round  the 
neck,  and  passing  under  the  breast  ;  and  the  swollen  and  tender  part 
should  be  rubbed  gently  two  or  three  times  a  day  with  a  little  olive-oil  [or 
Magnetic  Ointment].  By  those  means  it  will  usually  be  found  that  the 
size  of  the  swelling  will  gradually  diminish  and  the  tenderness  decrease, 
and  generally,  in  a  period  varjnng  from  a  few  days  to  a  fortnight,  all 
anxiety  about  the  condition  of  the  breast  will  have  disappeared.  In 
exceptional  cases,  however,  instead  of  becoming  smaller  the  swelling 
will  tend  to  increase,  the  tenderness  will  continue,  and  the  skin  over 
the  swelling  may  become  somewhat  reddened.  When  this  occurs,  and 
when  further  a  little  pitting  of  the  skin  is  noticed  on  pressure  of  the 
finger  over  the  swelling,  no  doubt  can  remain  that  the  imprisoned  milk 
has  become  decomposed,  and  that  an  abscess  has  developed,  and  meas¬ 
ures  have  to  be  taken  to  promote  its  speedy  evacuation, 


94 


THE  MOTHER  IN  RELATION  TO  THE  INFANT. 


Abscess  of  the  Breast  does  not  always  come  on  in  this  slow  and 
gradual  manner.  Sometimes,  on  the  contrary,  the  pain  in  the  breast 
may  come  on  suddenly,  accompanied  by  feelings  of  cold,  and  even 
shivering,  succeeded  by  feverishness  and  restlessness.  Again,  occa¬ 
sionally  the  shivering  and  feelings  of  cold  precede  any  pain  in  the 
breast ;  and  it  is  only  by  careful  examination  of  both  breasts  that  the 
medical  man  may  be  able  to  determine  to  what  the  fever  is  due.  In 

Fig.  16. 


MAMMARY  GLANDS  SHOWING  COURSE  OP  MILK-TUBES  TO  THE  NIPFLE. 

acute  cases  of  this  kind,  from  a  very  early  period,  redness  of  the  skin 
of  the  breast  covering  the  seat  of  inflammation  is  usually  noticeable,  and 
the  pitting  on  pressure  of  the  finger  can  generally  be  made  out  early. 
The  pain  and  tenderness  are  often  accompanied  by  considerable  throb¬ 
bing,  and  a  sense  of  much  increased  weight. 

The  fact  that  these  acute  abscesses  of  the  breast  usually  commence 
with  feelings  of  cold,  and  a  tendency  to  shiver,  often  gives  rise  to  the 
erroneous  idea  that  exposure  to  cold  has  been  the  exciting  cause  of  the 
inflammation.  It  is,  however,  exceedingly  doubtful  if  exposure  to  cold 
is  ever  alone  the  cause  of  acute  abscess  of  the  breast,  Mention  has  been 


ABSCESS  OP  THE  BREAST. 


95 


made  previously  of  the  cracks  or  fissures  which  sometimes  develop  ou 
the  nipples  at  the  commencement  of  nursing.  In  addition  to  the  dis¬ 
comfort  which  these  cause,  there  is  good  reason  to  think  that  to  their 
existence  is  due  most  of  the  acute  abscesses  which  occur  in  the  breast 
during  nursing.  They  afford,  as  it  were,  an  entrance  or  doorway 
through  which  impure  matter  may  enter  into  the  breast,  and  set  up 
the  acute  inflammation  which  terminates  in  abscess.  The  important 
fact  to  notice  in  relation  to  this  is,  that  it  is  not  apparently  the  existence 
of  the  fissures  which  causes  the  inflammation  ;  it  is  the  entrance  through 
the  fissures  of  impure  matter  which  may  possibly  have  formed  in*  the 
fissures  themselves,  but  which  may  also  have  been  conveyed  into  them 
by  unclean  hands,  or  clothes,  or  applications.  The  obvious  lesson  is  to 
emphasize  the  great  importance  of  absolute  cleanliness  during  nursing, 
and  this  even  when  no  apparent  fissure  exists.  A  fissure  or  crack  in 
the  nipple,  so  small  as  to  give  no  inconvenience  and  to  be  unobservable 
without  close  examination,  may  be  quite  large  enough  to  admit  the 
entrance  of  impure  matter  sufficient  to  generate  an  abscess.  For  this 
reason,  therefore,  as  well  as  for  others  already  mentioned,  the  practice 
of  bathing  the  nipple  carefully  after  each  time  of  nursing  should  be 
rigidly  adhered  to.  As  a  rule,  it  is  quite  sufficient  to  use  clean  warm 
water  for  the  purpose  ;  but  when  any  fissure  or  erosion  of  skin  exists, 
it  is  safer  to  use  for  mixing  with  the  water  some  antiseptic  soap.  [Or 
a  soap-suds  made  with  Boracic  Acid  Soap,  No.  31  of  the  Sanitary 
Bureau  list.  See  page  1230.  The  Magnetic  Ointment  is  useful  also  to 
aid  healing  of  fissures.] 

When  it  becomes  obvious  from  the  tenderness,  the  redness,  and  the 
pitting  on  pressure  that  a  swelling  of  the  breast  is  developing  into  an 
abscess,  the  two  objects  of  treatment  are  to  limit  the  size  of  the  abscess 
as  much  as  possible,  and  to  evacuate  the  contents  as  quickly  as  possi¬ 
ble.  The  greatest  comfort  is  usually  obtained  from  the  application  of 
warm  linseed  poultices,  and  from  frequent  fomentation  with  very  warm 
water.  At  the  same  time,  the  breast  should  be  carefully  supported  by 
a  handkerchief  passed  underneath  it,  and  tied  round  the  neck  in  the 
form  of  a  sling,  and  care  should  be  taken  to  prevent  all  pressure  from 
clothing.^  In  some  few  cases  the  application  of  ice  tied  into  a  water¬ 
proof  bag  and  laid  on  the  seat  of  the  abscess  gives  more  relief  than  the 
warm  application  ;  and  there  is  no  objection  to  its  employment  when 
found  effective  in  relieving  pain  and  subduing  inflammation.  An  ordi¬ 
nary  sponge-bag,  half-filled  with  broken  ice  and  closed  carefully  by  a 
large  cork  being  tied  into  the  open  end,  may  be  used  advantageously 
for  this  purpose.  When,  in  the  opinion  of  the  doctor,  the  time  has 
arrived  for  letting  out  the  matter  contained  in  the  abscess,  the  patient 
should  courageously  nerve  herself  to  permit  of  the  small  operation 
necessary  for  her  relief.  She  should  remember  that  it  is  for  the  benefit 


96  THE  MOTHER  IN  RELATION  TO  THE  INFANT. 

of  her  health  generally,  as  well  as  for  the  preservation  of  the  hreast, 
that  the  enclosed  matter  should  be  released,  and  that  her  power  of 
future  nursing  may  be  impaired  by  delay.  By  various  methods  the 
slight  incision  required  to  open  the  abscess  may  be  made  almost  with¬ 
out  pain,  and  the  escape  of  the  matter  will  always  be  followed  by 
great  and  immediate  relief. 

At  some  period  during  the  formation  of  an  abscess  in  the  breast 
the  question  will  generally  arise,  whether  nursing  is  to  be  continued  or 
given  up.  In  this  matter  the  mother  must  be  guided  entirely  by  the 

Fig.  17. 


CROSS  BAHDAGING  FOR  ABSCESS  OF  BREAST. 


advice  of  her  medical  attendant.  Iu  the  majority  of  cases,  even  after 
abscess  has  formed  in  one  breast,  it  is  not  only  possible  but  desirable  to 
continue  to  nurse  with  the  other,  while,  if  an  abscess  is  small  and  heals 
rapidly,  it  may  be  possible  to  resume  nursing  even  with  the  breast  in 
which  the  abscess  has  occurred.  In  some  cases,  the  extent  of  the 
abscess  and  considerations  relative  to  the  health  of  both  the  mother  and 
infant  will  dictate  the  cessation  of  nursing,  and  steps  will  have  to  be 


WHEN  TO  WEAN  THE  INFANT. 


J7 

taken  which  will  be  described  later  to  arrest  and  prevent  the  secretion 
of  milk. 

The  length  of  time  during  which  nursing  may  be  continued 

varies  much  in  different  mothers.  As  a  rule,  the  flow  of  milk  will  con¬ 
tinue  from  six  months  to  a  year  after  childbirth  ;  in  some  exceptional 
instances  it  may  be  found  to  last  from  eighteen  months  to  two  years. 
If  the  mother  remain  in  good  health,  and  the  infant  appears  to  flour¬ 
ish,  nursing  may  be  continued  with  safety  as  long  as  the  secretion  of 
milk  in  the  breasts  persists.  It  will  generally  be  found  that  after  eight 
or  nine  months’  nursing,  if  not  before  that  time,  the  amount  of  milk 
secreted  will  be  inadequate  to  the  wants  of  the  infant,  and  the  diet 
will  have  to  be  supplemented  by  the  addition  of  some  artificial  food. 
The  progress  of  the  infant  must  be  carefully  watched,  as  it  cannot 
be  depended  on  to  exhibit  signs  of  discomfort  from  hunger  when  only 
the  quality  of  the  mother’s  milk  has  deteriorated,  if,  at  the  same  time, 
the  quantity  is  maintained.  It  may  usually  be  presumed,  when  a  child 
without  any  appearance  of  illness  ceases  to  gain  weight  and  to  grow 
properly,  that  some  error  or  deficiency  exists  in  the  diet,  which  calls 
for  correction  or  addition. 

The  propriety  of  ceasing  to  nurse  her  infant  may  be  indicated 
to  the  mother  in  various  ways.  Most  commonly  the  secretion  of  milk 
becomes  diminished,  sometimes  gradually,  sometimes  somewhat  rap¬ 
idly,  and  it  becomes  obvious  that  even  when  sucking  strongly  the  baby 
obtains  but  little  milk,  and  that  with  difficulty  ;  and  in  consequence 
exhibits,  by  crying,  signs  of  dissatisfaction  and  hunger,  which  are  only 
appeased  by  the  administration  of  additional  food.  No  rush  of  milk 
into  the  breast  is  felt  by  the  mother  such  as  she  frequently  experiences 
when  the  breasts  are  secreting  copiously,  and  even  after  a  few  hours’ 
cessation  from  nursing  the  breasts  will  be  noticed  unfilled  and  flaccid. 

Not  unfrequently  the  first  indication  that  nursing  has  been  per¬ 
severed  in  sufficiently  long  is  afforded  by  seme  symptoms  of  deterioration 
in  the  health  of  the  mother.  She  may  feel  languid  and  incapable  of 
exertion,  become  somewhat  thinner,  and  look  pale  and  bloodless,  and 
suffer  from  headaches  and  loss  of  appetite.  A  very  characteristic 
symptom  of  the  depression  of  health  due  to  long  nursing  is  the  presence 
of  pain  in  the  back  between  the  shoulders,  usually  intensified  imme¬ 
diately  after  the  baby  has  been  nursed. 

When  either  the  failure  in  secretion  of  milk,  or  the  deterioration 
of  general  health,  indicates  that  the  question  of  ceasing  to  nurse  the 
infant  must  at  least  be  considered,  before  a  final  decision  is  arrived  at  it 
is  usually  desirable  to  try  if  assistance  can  be  given  to  the  mother  by  a 
more  nutritious  diet,  or  by  medical  tonic  treatment.  Frequently  it  will 
be  found  that  nursing  may  be  continued  for  a  month  or  two  longer  if 

some  addition  is  made  to  the  diet,  or  if  some  slight  stimulant  is  taken 

4 


98  THE  MOTHER  IN  RELATION  TO  TnE  INFANT. 

with  meals.  For  this  purpose  a  basin  of  thick  soup  with  some  toast  or 
bread  should  be  taken  in  the  forenoon  between  breakfast  and  the  mid¬ 
day  meal  ;  and  some  light  farinaceous  food  made  with  milk,  taken 
immediately  before  going  to  bed,  is  most  useful.  [A  light  gruel  of 
barley  or  oatmeal  suffices  well  for  this  extra  food-supply.]  Some 
tonic  medicine,  in  addition  to  the  more  liberal  diet,  aids  in  in¬ 
creasing  the  quantity  and  improving  the  quality  of  the  milk,  and  in 
restoring  the  health  of  the  mother.  This  will  usually  be  prescribed  by 
the  medical  attendant. 

If  the  increased  diet  and  tonic  treatment  just  described  have  no 
beneficial  effect  within  a  few  days  after  their  commencement,  it  must 
then  be  concluded  that  weaning  the  child  has  become  inevitable. 

Sometimes  the  flow  of  milk  in  the  breasts  is  arrested  quite  sud¬ 
denly  by  some  shock.  When  this  occurs,  it  is  very  exceptional  for  it 
to  be  restored,  and  cessation  of  nursing  follows  as  a  matter  of  necessity., 

Not  uncommonly,  nursing  comes  to  an  end  because  the  infant  de¬ 
clines  any  longer  to  take  the  breast.  This  generally  occurs  when  some 
artificial  food  has  been  used  to  supplement  the  milk  of  the  mother. 
The  child  seems  often  to  take  a  dislike  to  its  mother’s  milk  after  a  time, 
preferring  the  artificial  food  ;  and  may  refuse  entirely  to  suck  the 
breast,  sometimes  crying  when  its  mouth  is  placed  in  contact  with  the 
nipple.  It  is  probable  that  in  most  cases  of  this  kind  some  alteration 
has  taken  place  in  the  mother’s  milk,  rendering  it  unpalatable,  as  gen¬ 
erally  infants  show  a  strong  preference  for  the  breast  over  any  kind  of 
artificial  food. 

The  Recommencement  of  Henstruation  is  generally  consid¬ 
ered  an  indication  that  nursing  should  cease.  While  nursing,  mothers 
do  not,  as  a  rule,  have  any  menstrual  periods  ;  and  the  reappearance 
of  the  menstrual  flow  is  usually  accompanied  by  some  alteration  in  the 
milk,  which  causes  pain  and  discomfort  to  the  baby.  When  this  dis¬ 
comfort  is  not  great,  nursing  may  be  persevered  in  ;  but  if  the  men¬ 
strual  flow  returns  in  the  month  following,  it  is  wise,  both  in  the  inter¬ 
ests  of  the  child  and  the  mother,  to  terminate  the  nursing.  If  perse¬ 
vered  in  after  two  successive  periods  of  menstruation  have  been 
noticed,  the  mother  is  likely  soon  to  feel  the  strain  of  nursing  in  dete¬ 
rioration  of  health,  while  the  milk  she  supplies  is  seldom  appropriate  to 
the  wants  of  the  child. 

There  are  no  doubt  a  few  instances  where  mothers  menstruate 
regularly  during  the  process  of  gestation,  and  apparently  without  any 
ill  effects  to  themselves  or  their  infants,  but  such  cases  like  those  where 
menstruation  persists  during  pregnancy,  are  entirely  exceptional. 

Weaning. — When  the  resolution  to  give  tip  nursing  has  been  made 
for  any  reason  other  than  the  cessation  of  tlip  flow  of  milk,  some  meas¬ 
ures  will  usually  be  called  for  tb  arrest  the  secrptiop,  and  to  prevent 


SUGGESTIONS  FOR  WEANING. 


99 


any  injury  or  discomfort  to  the  mother  from  the  cessation  of  the 
function  of  the  breasts.  Sometimes  it  is  possible  to  evade  discomfort 
by  making  the  process  of  weaning  a  very  gradual  one,  lengthening 
by  degrees  the  intervals  of  nursing,  while  artificially  supplying 
the  wants  of  the  child.  When  some  little  time  can  be  allowed  to 
the  weaning  process,  it  will  usually  be  found  that  after  a  week  or  two 
of  lengthening  intervals,  nursing  can  be  given  up  altogether  without 
any  discomfort  beyond  perhaps  an  occasional  sense  of  fulness  in  the 
breasts,  and  it  may  be  a  slight  discharge  of  milk  from  the  nipples, 
which  will  generally  be  found  to  cease  entirely  after  two  or  three  days. 

When,  however,  suckling  has  to  be  given  up  Immediately,  without 
time  for  preparation,  some  difficulty  may  be  experienced  in  arresting 
the  secretion,  and  maintaining  the  breasts  in  comfort,  and  free  from 
excessive  distention.  The  mother  should  for  a  few  days  be  very  ab¬ 
stemious  in  diet,  taking  no  stimulants  of  any  kind,  and  very  little  meat. 
A  light  farinaceous  diet  is  to  be  preferred,  with  a  moderate  allowance 
of  milk  ;  much  fluid  of  any  kind  is  to  be  avoided.  Some  saline  medi¬ 
cine,  such  as  a  seidlitz  powder  or  a  large  teaspoonful  of  effervescing 
citrate  of  magnesia,  should  be  taken  in  water  every  morning ;  and 
if  this  does  not  act  sufficiently  on  the  bowels,  it  should  be  supple¬ 
mented  by  a  compound  rhubarb  pill,  or  a  teaspoonful  of  compound 
licorice  powder  taken  at  night.  Some  drugs,  notably  belladonna  and 
iodide  of  potassium,  have  considerable  effect  in  reducing  the  flow  of 
milk,  and  may  be  prescribed  by  the  medical  attendant. 

As  a  local  application  to  the  breast,  for  the  purpose  of  arresting 
the  secretion,  eau-de-Cologne,  diluted  with  an  equal  quantity  of  water, 
is  very  effective.  It  is  best  applied  to  the  breasts  on  lint,  which,  satur¬ 
ated  with  the  eau-de-Cologne  and  water,  should  be  laid  over  the  whole 
breast,  and  covered  with  some  cotton-wool.  Whiskey  or  gin  may  be 
employed  as  substitutes  for  eau-de-Cologne,  being  almost  equally 
effective,  if  not  quite  so  pleasant  in  odor.  Where  the  breasts  are  not 
too  tender  to  admit  of  a  little  gentle  pressure,  the  application  of  a  broad 
flannel  bandage  round  the  chest  outside  the  cotton-wool  will  assist 
much  in  preventing  the  secretion  and  promoting  the  absorption  of  the 
milk.  The  flannel  bandage  should  be  wide  enough  to  cover  the  breasts 
completely,  and  should  be  drawn  as  tightly  as  is  consistent  with  com¬ 
fort,  and  secured  with  safety-pins.  Sometimes  gentle  rubbing  of  the 
breasts  will  be  found  of  great  use  in  arresting  the  flow  of  milk.  The 
rubbing  should  be  in  the  direction  from  the  nipple  toward  the  base  of 
the  breasts,  and  should  be  continued  for  ten  minutes  or  a  quarter  of 
an  hour  at  a  time,  and  repeated  two  or  three  times  daily.  It  is  conven¬ 
ient  to  use  some  oily  material  to  facilitate  the  rubbing,  and  for  this 
purpose  either  plain  olive-oil  or  camphorated  oil  may  be  employed. 

The  local  application  of  belladonna  is  of  much  value  in  promoting 


IOO 


THE  MOTHER  IX  RELATION  TO  THE  INFANT. 


the  absorption  of  milk  in  the  breasts,  and  its  use  may  be  conveniently 
combined  with  the  rubbing  described  above.  To  this  end  liniment  of 
belladonna  may  be  mixed  in  equal  parts  with  the  camphorated  oil. 

When  the  breasts  are  too  tender  to  bear  any  rubbing,  belladonna 
may  be  painted  over  them  in  the  form  of  a  glycerine  composed  of 
equal  parts  of  plain  glycerine  and  extract  of  belladonna.  This  glycer¬ 
ine  should  be  applied  twice  or  thrice  daily,  and  the  breasts  covered 
afterward  with  cotton-wool  or  lint,  pressure  with  a  flannel  bandage 
being  used  in  addition  when  it  can  be  borne  with  comfort.  Belladonna 
may  also  be  used  in  the  form  of  a  plaster,  cut  to  the  shape  of  the 
breast,  and  made  to  adhere  to  its  surface.  When  this  method  is  em¬ 
ployed,  care  must  be  taken  to  cut  an  opening  in  the  plaster  for  the 
nipple,  so  that  any  exuded  milk  may  escape  without  difficulty. 

By  a  selection  or  combination  of  these  various  methods  of  reducing 
and  preventing  the  secretion  of  milk,  the  process  of  -weaning  can  gener¬ 
ally  be  effected  in  a  few  days  with  comparatively  little  discomfort. 
There  is  no  reason  for  the  mother  to  lay  up  or  abandon  her  usual  occu¬ 
pations  during  this  period,  but  care  should  be  taken  to  avoid  cold  and 
over-fatigue,  which  might  be  injurious  by  exciting  a  tendency  to  in¬ 
flammation  in  the  breasts. 


FROM  JOHN  ROGER’S  STATUETTE. 


I 


PART  III. 


THE  CHILD. 


CHAPTER  XI. 


Normal,  Development  op  the  Child. 

Average  Size  and  Weight  at  Birth;  Variations;  Description  of  Skin;  Of  Head 
Sutures  of  Head;  Fontanelles;  Cry;  Grasp;  Animal  Heat;  Necessity  or 
Warmth;  Tendency  to  Sleep;  Action  of  Bowels  and  Kidneys;  Meconium- 
Normal  Excretion  of  Bowels;  Secretion  of  Kidneys;  Indication  of  Disorder; 
Recui-ring  Craving  for  Food;  Average  Rate  of  Growth  in  Height  and 
Weight;  Increase  in  Intelligence;  Development  of  Sight  and  Hearing; 
Tears  and  Smiles;  Amount  of  Sleep;  Process  of  Teething;  Development  of 
Walking  Powers;  Art  of  Speech;  Second  Dentition;  Absorption  of  First 
Teeth;  Puberty  in  Girls ;  Menstruation;  Occasional  Discomfort;  Necessity 
of  Care  during  Period;  Caution  in  Use  of  Stimulants;  Manifestations  of 
Mental  and  Moral  Disorder;  Puberty  in  Boys;  Nervous  Derangements. 

The  size  and  the  weight  of  infants  born  at  full  time  vary  within 

fairly  wide  limits.  The  average  weight  of  a  new-born  male  infant  is 

about  seven  pounds,  of  a  female  infant  about  six  and  a  half  pounds, 

while  their  height  or  length  averages  about  eighteen  inches,  the  male 

averaging  a  little  more  than  the  female  in  height  as  well  as  in  weight. 

First  children  not  unfrequently  fall  short  of  this  average,  and  infants 

born  at  full  time  under  unfavorable  circumstances  may  occasionally 

be  found  to  weigh  only  four  or  five  pounds,  and  to  measure  not  more 

than  sixteen  inches.  On  the  other  hand,  a  weight  and  size  considera- 

bly  above  the  average  is  not  unfrequent,  babies  being  often  found  to 

weigh  nine  or  ten  pounds  at  birth,  and  to  measure  twenty-one  or 

twenty-two  inches.  Instances  of  weight  much  beyound  this  are  rare  ; 

the  very  extreme  recorded  is  a  male  child  about  eighteen  pounds  in 

weight  and  thirty-two  inches  in  length. 

When  first  born  the  skin  of  the  infant  is  of  a  pale  red  color,  and  is 

often  covered  with  a  whitish-yellow  greasy  material,  which  is  washed 

off  by  the  nurse  before  the  baby  is  dressed.  When  the  skin  has  been 

101 


102 


NORMAL  DEVELOPMENT  OF  THE  CHILD. 


washed,  it  will  be  observed  to  be  covered  with  fine  downy  hair,  the 
fineness  of  which  varies  much  in  different  children.  While  sometimes 
the  down  is  so  fine  and  short  as  to  be  observable  only  on  close  inspec¬ 
tion,  frequently  it  is  very  distinct,  giving  a  markedly  furry  character 
to  the  surface  of  the  skin.  If  a  baby  is  healthy,  and  born  after  the 
full  time  of  pregnancy  has  elapsed,  its  limbs  are  firm,  plump,  and 
elastic,  and  its  body  well  covered  with  fat,  so  that  the  underlying 
bones  are  well  concealed.  It  has  well-developed  nails  on  its  fingers 
and  toes,  the  nails  reaching  fully  to  the  ends  of  the  extremities  to 
which  they  are  attached. 

Fig.  18.  Fig.  19. 


THE  LOOSE-JOINTED  SKULL  OP  AN  INFANT,  SHOWING  THE  ANTERIOR  FONTANELLE 
(a);  THE  POSTERIOR  FONTANELLE  (b) ;  SAGITTAL  SUTURE  (e) ;  CORONAL  SUTURE 
(d);  FRONTAL  BONES  (1);  PARIETAL  OR  SIDE  BONES  (2);  AND  OCCIPITAL  BONES  (3). 


In  proportion  to  the  body,  the  head  of  a  newly  born  infant  appears 
large,  forming  generally  about  one-fourth  of  the  total  length  of  the 
child.  If  the  infant  is  healthy  and  strong,  the  head  is  firm  and  well 
shaped,  and  the  attachment  to  the  body  by  the  neck  is  strong  and 
resistant.  If  an  infant  is  weakly,  the  head  is  usually  found  rather 
flaccid,  and  its  shape  is  easily  altered  by  pressure,  while  the  neck 
appears  feeble,  and  sometimes  thin,  and  lengthened  by  muscular  relax¬ 
ation.  At  birth  the  “bones  enclosing  the  brain  are  not  rigidly  united  as 
they  are  in  adult  life.  The  exterior  of  the  skull  is  made  up  of  a 
variety  of  bones  rather  loosely  attached  to  each  other,  and  admitting 
of  considerable  alteration  of  the  shape  of  the  head  under  pressure. 
This  capacity  for  alteration  is  of  great  value  during  childbirth,  as  it 
permits  of  the  head  adjusting  itself  to  the  irregularity  of  the  passage 
through  which  birth  takes  place.  The  lines  along  which  the  bones 
are  joined  to  each  other  are  generally  visible  to  the  eye  at  birth.,  and 
are  always  distinguishable  by  touch  ;  they  are  known  technically  as 
sutures.  The  principal  of  these  sutures  are  known  as  the  coronal 
suture,  the  sagittal  suture,  and  the  occipital  suture.  The  coronal  one 


CARE  OF  THE  NEWLY  BORN  INFANT. 


103 

can  be  felt  and  seen  across  the  top  of  the  head  in  front  just  behind  the 
forehead.  The  sagittal  suture  extends  along  the  crown  of  the  head, 
from  the  middle  of  the  coronal  suture  in  front,  to  a  point  in  the  centre 
of  the  back  of  the  head,  where  it  meets  the  occipital  suture.  The 
occipital  suture  is  angular  in  shape,  the  point  of  the  angle  being 
directed  to  the  posterior  end  of  the  sagittal  suture,  and  the  sides  diverg¬ 
ing  downward  and  outward  from  thence.  The  sutures  are  simply 
spaces  between  the  bones  of  the  head,  occupied  by  soft  cartilage ;  and 
it  is  mainly  the  hardness  of  the  bones  on  each  side  which  renders  them 
so  obvious  to  touch.  At  either  end  of  the  sagittal  suture  the  spaces 
become  somewhat  wider,  and  two  small  areas  of  softness  become  appar¬ 
ent,  which  are  known  under  the  name  of  fontanelles.  The  anterior 
of  these  is  of  a  diamond  shape,  and  varies  in  size  in  different  infants 
from  a  diameter  of  half  an  inch  to  one  of  two  inches.  The  posterior 
one  is  triangular  in  shape,  the  sides  of  the  triangle  measuring  from 
half  an  inch  to  one  inch  or  more  in  length.  As  the  infant  grows,  these 
fontanelles  are  gradually  filled  up  by  growth  of  bone,  and  in  a  healthy 
child  at  the  end  of  two  years  will  be  found  to  be  obliterated.  Their 
importance  from  the  present  point  of  view  is  found  in  the  indication 
they  afford  of  the  progress  in  development  and  health  of  the  infant. 
In  weakly  infants  the  fontanelles  are  often  found  to  close  very  slowly, 
and  may  occasionally  be  observed  even  to  increase  in  size  for  a  few 
months  after  birth,  instead  of  gradually  diminishing.  The  mobility 
permitted  by  the  existence  of  sutures  and  fontanelles  frequently  admits 
of  considerable  apparent  obliquity  of  shape  of  the  head  during  the  first 
few  days  of  life.  During  childbirth  the  head  of  the  child  is  often 
much  altered  in  shape,  and  immediately  after  birth  one  side  of  the  head 
may  be  observed  larger  than  the  other,  or  the  forehead  may  seem 
much  flattened  and  the  back  of  the  head  lengthened.  Such  alterations, 
resulting  as  they  do  from  pressure  before  birth,  need  not  be  regarded 
with  any  anxiety,  as  in  a  few  days  the  elasticity  of  the  head  will  restore 
the  natural  contour,  and  all  traces  of  pressure  will  disappear.  Healthy 
babies  born  at  full  time  usually  cry  lustily  immediately  after  birth, 
the  cry  being  often  the  first  indication  of  their  independent  existence. 
At  this  early  stage  it  is  probably  caused  by  the  discomfort  arising  from 
sensations  of  cold.  In  the  womb  the  infant  is  surrounded  by  a  watery 
fluid  with  a  temperature  of  about  100°  F. ;  on  birth  it  is  ushered  into  an 
atmosphere  which  rarely  exceeds  60°  F.,  and  the  baby’s  appreciation  of 
the  reduction  of  temperature  is  often  indicated  by  marked  shivering  as 
well  as  by  loud  crying.  The  crying  and  shivering  usually  cease  imme¬ 
diately  that  the  child  is  enveloped  in  a  warm  blanket.  Some  discom¬ 
fort  in  addition  is  felt  by  the  child  from  the  absence  of  general  support 
to  the  body  after  birth.  While  in  the  womb  some  pressure  is  exerted 
on  all  the  surface  of  the  child’s  body  by  the  pressure  of  the  abdominal 


NORMAL  DEVELOPMENT  OF  THE  CHILD. 


104 

muscles  of  the  mother  acting  through  the  medium  of  the  amniotic 
fluid  ;  after  birth  this  sense  of  pressure  and  support  is  lost.  That  its 
loss  is  felt  by  the  infant  is  evinced  by  its  restlessness  even  when  kept 
perfectly  warm,  unless  some  support  is  given  to  it  by  blankets  or 
pillows,  and  also  by  the  strong  tendency  of  newly  born  infants  to 
grasp  firmly  with  the  hand  anything  with  which  they  may  come  in 
contact.  A  newly  born  child  seems  to  have  an  absolute  dread  of  being 
left  without  any  support,  and  clings  tenaciously  to  the  apron  of  the 
nurse  or  to  the  blanket  in  which  it  may  be  rolled.  If  a  baby  is  strong 
and  well  nourished,  its  grasp  is  firm,  and  it  moves  both  its  arms  and 
legs  with  activity.  When  maintained  in  proper  warmth,  its  hands  and 
feet  are  found  to  remain  warm  and  natural  in  color,  the  face  looks  pink 
and  healthy,  and  the  breathing  is  regular  and  full.  If  exposed  much 
to  cold,  however,  even  a  strong  baby  will  soon  show  signs  of  lessened 
vitality.  The  fingers  and  toes  will  become  blue  and  cold,  the  face 
somewhat  pinched,  and  the  nose  pale,  and  the  breathing  somewhat 
shallow  ;  and  w'hen  the  child  cries  the  voice  will  be  found  feebler  and 
the  cry  more  moaning  in  character.  These  alterations  invariably  indi¬ 
cate  the  necessity  of  great  care  in  maintaining  warmth,  and  may  call 
for  the  early  attention  of  the  medical  attendant. 

During  the  first  one  or  two  months  of  a  child’s  life,  almost  the 
whole  of  its  time  is  devoted  to  sleep,  except  when  occupied  in  receiving 
food.  The  tendency  of  a  healthy  infant  under  two  months  old  is  to 
fall  asleep  immediately  after  taking  nourishment,  and  to  remain  asleep 
until  it  again  wakens  under  the  stimulus  of  hunger.  This  rhythm  is 
liable  to  interference  from  various  causes,  the  most  common  of  which 
is  discomfort  in  digestion.  A  considerable  proportion  of  babies  suffer 
from  some  discomfort  after  taking  food,  and  indicate  the  fact  by  rest¬ 
lessness,  by  frequent  crying,  by  flatulence,  and  by  occasional  sickness. 
Whatever  discomfort  a  baby  suffers  from,  it  inclines  to  attribute  to 
hunger,  and  if  the  opportunity  is  given  to  it,  it  will  always  try  to  allay 
the  discomfort  by  the  imbibition  of  food.  This  is  apparently  the  result 
of  a  healthy  instinct.  A  healthy  baby  properly  tended  ought  to  know 
of  no  discomfort  except  hunger,  and  when  discomfort  of  any  kind 
exists  it  instinctively  refers  it  to  this  cause.  It  is  for  the  more  expe¬ 
rienced  nurse  or  mother  to  differentiate  between  the  causes  of  discom¬ 
fort,  and  to  apply  the  proper  remedy.  Too  frequently  the  discomfort 
resulting  from  indigestion  is  mistaken  for  hunger,  and  the  disorder  in¬ 
creased  by  the  administration  of  more  food  before  the  previous  meal 
has  been  healthily  disposed  of. 

■  Generally  both  the  bowels  and  the  kidneys  of  a  newly  born 
Infant  act  once  of  twice  during  the  first  twenty-four  hours  of  life.  The 
first  one  or  two  actions  of  the  bowels  differ  from  the  subsequent  ones, 
being  generally  very  dark  in  color,  sometimes  almost  black.  What 


GROWTH  AND  PROGRESS. 


105 


passes  from  the  bowel  at  this  time  is  known  technically  as  meconium , 
and  consists  of  secretions  from  the  liver  and  bowel  during  intra-uterine 
life.  After  the  meconium  has  passed  away,  and  the  baby  has  been  fed 
once  or  twice  with  milk,  the  motions  become  yellow  in  color,  and  of 
the  consistency  of  thick  cream.  This  color  continues  during  the  first 
one  or  two  years  of  life,  becoming  gradually  slightly  darker.  The 
motions  are  usually  unformed  during  the  first  few  months  of  life, 
consisting  merely  of  a  uniform  mass,  unless  the  form  has  been  modified 
by  constipation,  when  hard  lumps  of  faeces  majr  be  passed.  On  an 
average,  a  young  baby’s  bowels  will  act  three  or  four  times  in  the 
twenty-four  hours.  At  the  same  time  two  good  motions  daily  are  quite 
compatible  with  perfect  health,  while  five  or  six  actions  daily  would 
not  be  considered  abnormal  if  the  character  of  the  motions  remained 
quite  healthy.  Anything  beyond  that  would  be  considered  excessive, 
and  would  probably  call  for  some  alteration  in  diet.  The  excretion 
from  the  bowel  of  a  healthy  infant  has  a  very  slight  odor  ;  marked 
fetor  of  the  motions  is  always  indicative  of  some  failure  in  digestion, 
or  some  error  in  diet. 

The  Secretion  from  the  Kidneys  in  infants  is  usually  of  a  very 
pale  color,  is  not  irritating  to  the  skin  with  which  it  comes  in  contact, 
and  imparts  almost  no  smell  to  the  diapers  which  absorb  it.  The 
bladder  is  emptied  with  very  varying  frequency  in  different  children. 
Five  or  six  times  daily  is  usual  ;  in  children  who  take  nourish¬ 
ment  very  freely,  eight  or  ten  times  a  day  is  not  uncommon.  No 
amount  of  frequency  need  excite  anxiety  if  the  urine  appears  normal 
in  quality.  Indications  of  disorder  are  found  in  fetor  of  the  diapers, 
increased  depth  of  color,  presence  of  small  quantities  of  red  sand,  and 
irritation  of  the  thighs  of  the  child.  The  presence  of  a  small  quantity 
of  sand  or  gravel  in  the  urine  of  very  young  babies  is  only  very  occa¬ 
sional,  and  is  not  to  be  viewed  with  any  anxiety  ;  but  if  it  occurs  at  all 
frequently,  some  alteration  of  diet  is  necessary.  Irritation  and  redness 
of  the  thighs  of  a  child  ought  always  to  call  attention  to  the  condition 
of  the  urinary  secretion.  It  may  of  course  occur  when  the  urine  is 
perfectly  healthy,  if  the  diapers  are  not  changed  with  sufficient  fre¬ 
quency,  but  in  a  well-tended  child  its  existence  will  always  excite  the 
suspicion  of  some  unhealthy  condition  of  the  urine.  Nurses  are  some¬ 
what  apt  to  blame  the  washing  of  the  diapers  when  irritation  of  this 
kind  occurs  ;  the  possibility  of  this  source  of  irritation  can  always  be 
tested  by  making  use  for  a  week  of  diapers  washed  at  home,  or  of  the 
cotton-wool  and  gauze  diapers  sold  under  the  title  of  “bapkins.” 

Growth  and  Progress. — Every  healthy  ‘child  is  born  with  a 
periodically  recurring  craving  for  food,  evinced  by  a  tendency  to 
suck  anything  placed  between  its  lips,  and  a  readiness  to  swallow  any 

thing  pleasing  to  its  tongue  or  palate.  If  its  lips  and  mouth  and  nose 

4ft 


jo6  NORMAL  DEVELOPMENT  OF  THE  CHILD. 


are  properly  formed,  and  its  breathing  power  good,  it  can  suck  even 
from  its  earliest  days  with  considerable  effect,  and  evidently  derives 
much  pleasure  from  exercising  this  function  if  a  due  reward  is  obtained 
in  the  form  of  a  satisfactory  supply  of  milk.  Obtaining  this,  and  exer¬ 
cising  its  other  functions  healthily,  the  young  infant  usually  grows 
with  considerable  rapidity.  Often  an  increase  of  weight  of  four  to  six 
ounces  weekly  will  be  observed  ;  sometimes  even  half  a  pound  may  be 
gained  in  one  week.  The  progress  in  weight  is  seldom  quite  uniform  ; 
in  one  week  a  great  advance  may  be  made,  while  in  the  next  compara- 

AVERAGE  HEIGHTS  AND  WEIGHTS  OF  CHILDREN. 

(Adapted  from  “A  Text-Book  of  Human  Physiology," 
by  Landois  and  Stirling.) 


Age  in  years. 

Ileight  in  Inches. 

Weight  in  Pounds. 

Males. 

Females. 

Males. 

Females. 

At  birth 

1934 

19 

7 

634 

1 

2714 

27 

22 

2034 

2 

31 1 2 

31 

2634 

25 

3 

34 

3334 

29 

2714 

4 

3634 

36 

33 

31 

5 

39 

38 

363^ 

34 

6 

41 

4034 

3934 

3634 

7 

4334 

43 

4414 

4034 

8 

46 

45 

48?4 

4834 

9 

48 

47 

5234 

49  04 

10 

50^ 

49 

5734 

53(4 

11 

52 

50 

61 

5734 

12 

5334 

52 

68 14 

67  ‘ 

13 

55 

54 

7734 

76 

14 

58 

5634 

89 

8334 

tively  small  progress  is  noticed.  On  an  average,  during  the  first  year 
a  gain  of  more  than  twelve  pounds  is  observed,  perhaps  two- thirds  of 
which  may  be  made  in  the  first  six  months,  the  increase  in  weight 
being  somewhat  slower  as  the  child  grows  older.  Children  who  are 
over  the  average  weight  at  birth  generally  progress  for  the  first  one  or 
two  years  with  greater  rapidity  than  those  who  have  been  born  under 
the  average  weight.  Coincidently  with  increased  weight,  increase  in 
height  or  length  is  observed  ;  during  the  first  year  a  gain  of  eight  or 
nine  inches  in  length  is  usual.  During  the  second  year  of  life  increase 
of  weight  and  height  does  not  progress  at  such  a  rapid  rate ;  the 
usual  increase  of  weight  during  this  period  is  from  four  to  five  pounds, 
while  the  stature  increases  by  four  or  five  inches.  After  the  end  of  the 
second  year,  speaking  generally,  about  four  pounds  is  added  to  the 


FIRST  INDICATIONS  OF  INTELLIGENCE. 


107 

weight  yearly,  while  the  height  is  increased  by  a  little  more  than  two 
inches  annually.  A  table  of  average  measurements  of  weight  and 
height  at  different  ages  of  both  males  and  females  is  shown  opposite. 

First  Indications  of  Intelligence. — In  the  early  days  of  infancy, 
a  baby  cannot  be  said  to  manifest  much  intelligence.  Although 
usually  opening  its  eyes  immediately  after  birth,  its  power  of  vision  is 
very  slight,  and  a  finger  can  be  approached  close  to  its  eyes  without 
exciting  them  to  wink.  It  is  only  after  twro  or  three  weeks  existence 
that  it  will  be  observed  to  follow  with  its  eyes  any  bright  light  moved 
in  front  of  them  ;  and  few  babies  will  recognize  the  individual  faces  of 
the  mother  or  nurse  until  at  least  two  months  old.  If  before  this  age 
the  baby  cries  when  carried'  by  one  person  rather  than  by  another, 
it  is  due  to  differences  in  the  comfort  of  the  manner  in  which  it  is 
held,  rather  than  to  personal  preferences.  Many  nurses  take  consider¬ 
able  care  to  protect  the  eyes  of  infants  from  bright  light,  but  this  care 
is  usually  quite  unnecessary,  except  when  the  baby  may  be  suffering 
from  actual  inflammation  of  the  eyelids.  The  eyelids  of  newly  born 
infants  are  somewhat  prone  to  inflammation,  resulting  usually  from  irri¬ 
tation  received  during  the  process  of  birth  ;  and  it  is  quite  a  mistake 
to  attribute  the  inflammation  of  the  lids  to  any  exposure  to  light. 
Babies  from  two  to  four  months  old  use  their  eyes  to  greater  purpose, 
and  will  often  be  found  capable  of  recognizing  the  faces  of  their 
mother  and  father,  and  will  cry  on  being  confronted  with  a  strange 
face. 

At  from  three  to  six  months  of  age  they  will  look  about  them 
freely,  and  will  be  attracted  by  any  bright-colored  article,  and  will 
attempt  to  seize  writh  the  hand  objects  held  in  front  of  them. 

The  faculty  of  hearing  in  infants  usually  requires  some  time  for 
development.  It  is  true  that  from  the  commencement  of  life  an  infant 
wdll  start  when  any  very  loud  noise  is  made,  but  this  is  more  probably 
due  to  the  general  shock  from  vibration  than  to  any  special  auditory 
sense.  It  is  seldom  that  a  baby  wdll  seem  to  regard  any  special  sound 
until  it  is  about  three  months  old.  At  that  age  it  may  be  found  to 
turn  its  liefid  at  the  voice  of  its  mother  or  nurse,  and  may  show  its 
attention  drawn  by  the  striking  of  a  clock.  From  that  age  onward 
many  babies  seem  to  be  soothed  by  the  singing  of  their  mother,  and 
some  infants  of  six  months  wdll  show  distinct  pleasure  at  the  sound  of 
music,  and  interest  in  the  ticking  of  a  watch  held  to  their  ears. 

Babies,  as  has  been  observed  more  than  once,  are  capable  of  crying 
from  the  moment  of  their  birth,  and  fewr  of  them  are  backward  in 
exercising  this  power.  Although  able  to  cry,  they  have  not,  however, 
for  one  or  two  months  the  ability  to  shed  tears.  After  crying  for  a 
little  time  the  eyes  of  a  very  young  infant  may  be  noticed  to  be  moist, 
but  the  flow'  of  real  tears  from  a  baby’s  eyes  is  seldom  observable  until 


io8  NORMAL  DEVELOPMENT  OF  THE  CHILD. 

it  lias  attained  the  age  of  three  months.  Babies  smile  when  very 
young ;  a  distinct,  pleased  smile  may  often  be  elicited  by  tickling  or 
patting  the  face  of  a  baby  one  month  old,  but  audible  laughter  is  very 
uncommon  in  infants  under  five  or  six  months  of  age,  and  many  chil¬ 
dren  never  laugh  heartily  until  they  have  attained  the  age  of  one  year 
or  more. 

Sleep. — Babies  vary  considerably  in  the  amount  of  sleep  they  can 
take  and  enjoy.  During  the  first  month  of  life  generally  an  infant 
sleeps  almost  continuously,  except  when  nursing  or  being  fed  or  washed. 
When  more  than  a  month  old,  it  will  often  lie  awake  for  one  or  two 
hours  at  a  time,  quite  happy  if  in  comfort,  especially  if  lying  in  the 
nurse’s  lap  or  carried  in  her  arms.  When  twTo  or  three  months  old,  if 
a  fairly  strong  child,  it  will  begin  to  sit  up  a  little  in  the  nurse’s  or 
mother’s  arms,  its  back  becoming  firmer,  and  the  neck  bearing  the  head 
well  when  a  little  support  is  given  by  the  arm. 

At  this  age  it  will  remain  awake  for  two  hours  or  more  at  a  time  ; 
and  when  it  reaches  the  age  of  six  months  it  may  remain  awake  for 
three  or  four  hours,  sleeping  only  for  an  hour  or  two  in  the  forenoon 
and  afternoon,  and  continuously  during  the  night.  From  the  very 
commencement  of  life  it  is  always  well,  as  far  as  possible,  to  induce  the 
infant  to  sleep  all  through  the  night,  wutli  only  intervals  for  feeding. 
No  doubt  this  is  not  unfrequently  a  matter  of  some  difficulty  ;  and 
with  some  young  infants  it  is  impossible,  wakefulness  at  night  being 
not  uncommon  during  the  first  few  months  of  existence.  But  patient 
effort  in  soothing  the  infant,  combined  with  attention  to  keeping  it 
awake  and  interesting  it  during  the  day,  will  often  overcome  the  ten¬ 
dency  to  nocturnal  wakefulness,  and  the  mother  will  gain  the  rewrard 
of  her  cares  in  the  enjoyment  of  peaceful  nights. 

From  eight  months  to  a  year  old  an  infant  will  generally  sleep  two 
or  three  hours  in  the  forenoon,  remaining  awake  after  its  forenoon  rest 
until  six  or  seven  in  the  evening  This  sleep  during  the  forenoon  will 
often  be  continued  during  the  first  two  or  three  years  of  life,  and 
should  always  be  encouraged.  While  at  the  age  of  one  year  it  may 
last  for  two  or  three  hours,  as  the  child  becomes  older  the  duration 
may  be  shorter,  but  even  if  the  sleep  only  lasts  for  one  hour  in  the 
middle  of  the  day,  it  is  of  much  value  to  a  child  of  two  years  old  or 
even  more. 

From  earliest  infancy  until  at  least  the  fifth  year,  the  night’s  rest 
should  be  as  nearly  as  possible  one  of  twelve  hours.  Generally  speak¬ 
ing,  the  child  should  be  undressed  and  put  to  bed  before  seven  in  the 
evening,  and  should  not  be  taken  up  and  dressed  again  until  after  seven 
in  the  morning,  the  disturbance  for  feeding  and  for  other  purposes 
during  the  night  being  effected  as  gently  as  possible.  Even  in  very 
young  infants  there  should  be  a  change  of  clothing  before  lying  down 


PROCESS  OF  TEETHING. 


109 

for  the  night’s  rest,  and  this  change  should  be  made  at  the  same  hour 
every  evening. 

Process  of  Teething. — Babies  do  not  as  a  rule  begin  to  cut  any 
teeth  until  they  have  attained  the  age  of  six  or  seven  months.  At  birth 
the  gums  are  smooth  and  moderately  soft,  although  firm,  and  they  gen¬ 
erally  remain  in  this  condition  for  three  or  four  months.  They  may 
then  be  observed  to  become  somewhat  less  smooth,  and  a  little  swollen 
toward  the  front  of  the  mouth  ;  and  the  apparent  increase  of  fulness 
is  frequently  accompanied  by  increased  secretion  of  saliva,  and  a  ten¬ 
dency  to  “dribble.”  This  condition  may  continue  for  a  month  or  two 
before  any  teeth  can  be  felt  projecting  under  the  surface  of  the  gum, 
during  which  time  the  baby  usually  exhibits  a  strong  tendency  to  bite 
anything  which  is  placed  in  its  hand,  in  default  of  which  it  frequently 
employs  its  own  fingers.  The  teeth  which  usually  erupt  first  through 
the  gums  are  the  two  central  ones  in  the  lower  jaw;  and  these  are 
generally  followed  in  two  or  three  weeks  by  the  corresponding  ones  of 
the  upper  jaw.  As  a  not  unfrequent  exception,  the  upper  ones  appear 
before  the  lower  ones.  These  teeth  which  appear  in  the  middle  of  the 
upper  and  lower  jawT  are  known  as  the  central  incisors.  Although 
appearing  as  a  rule  about  the  seventh  month  of  life,  they  not  unfre- 
quently  are  observed  to  erupt  two  or  three  months  earlier  ;  occasionally 
babies  are  born  with  them  fully  developed,  but  such  instances  are  very 
exceptional.  On  the  other  hand,  the  eruption  of  the  teeth  may  be 
considerably  postponed,  and  infants  arc  not  uncommonly  seen  who  have 
attained  the  age  of  twelve  months  without  the  eruption  of  any  teeth. 
When  the  cutting  of  the  first  teeth  has  been  delayed  as  k/ng  as  a  year 
from  birth,  there  is  generally  ground  for  suspecting  some  slight  weak¬ 
ness  of  health  ;  and  this  suspicion  is  strengthened  if  coincidently  with 
the  late  eruption  of  teeth  exceptional  openness  of  the  fontanelles  of  the 
head  is  observed.  Too  much  importance  must  not,  however,  be  at¬ 
tached  even  to  the  coexistence  of  these  two  indications  of  dilator}' 
development ;  but  their  presence  may  suggest  the  propriety  of  medi¬ 
cal  advice  as  to  conditions  of  diet  and  hygiene  which  may  promote  the 
general  health  and  more  rapid  progress  of  the  infant. 

Some  two  months  after  the  central  incisors  have  erupted,  the  front 
teeth  at  each  side  of  them,  which  are  called  the  lateral  incisors,  usually 
make  their  appearance,  the  ones  in  the  lower  jaw  more  generally  ap¬ 
pearing  before  those  in  the  upper  jaw.  At  the  age  of  twelve  months  or 
soon  afterward  the  first  double  teeth  come  through  the  gum,  occupying 
places  some  little  distance  behind  the  lateral  incisors,  from  which 
they  are  separated  by  a  space  destined  for  the  appearance  somewhat 
later  by  the  canine  or  eye  teeth.  The  double  teeth  are  known  techni¬ 
cally  as  molar  teeth,  and  the  ones  which  come  through  first  and  lie 
behind  the  spaces  for  the  canine  teeth  are  termed  the  anterior  molar 


no 


NORMAL  DEVELOPMENT  OF  THE  CHILD. 


teeth.  They  are  somewhat  broad  on  the  top,  unlike  the  incisor  teeth, 
which  have  a  sharp  knife-like  edge,  and  are  furrowed  slightly,  having 
a  ridge  on  the  outside  and  inside,  and  a  hollow  between  the  two  ridges. 
The  ridges  often  break  through  the  gums  separately,  leaving  the  fur¬ 
row  covered  by  the  gum  for  a  few  days  longer,  and  present  the  decep¬ 
tive  appearance  of  two  teeth  side  by  side  until  the  bursting  of  the  gum 
discloses  the  furrow  uniting  them. 

The  canine  or  eye  teeth  usually  appear  when  the  child  has  attained 
the  age  of  from  eighteen  to  twenty  months.  They  come  in  the  spaces 
between  the  lateral  incisors  and  the  anterior  molars,  occupying  the 
angles  of  the  mouth,  and  are  more  pointed  than  any  of  the  other  teeth. 

The  first  set  of  teeth  of  the  child  is  completed  by  the  eruption  ( 1 
the  posterior  molar  teeth,  which  appear  behind  the  anterior  molar  teeth 
generally  about  the  end  of  the  second  year  of  life.  The  posterior  molar 
teeth,  like  the  anterior,  are  double  teeth  with  two  ridges  and  a  furrow 
on  their  opposing  surfaces. 

From  the  description  given  it  will  be  seen  that  the  first  set,  or,  as 
it  is  often  called,  the  ‘  milk”  set  of  teeth  of  a  child,  is  made  up  of 
twenty  teeth,  symmetrically  arranged  in  the  upper  and  lower  jav  s 
Recapitulating  their  names  from  the  centre  in  front  toward  the  sides, 
there  are  the  upper  and  lower,  right  and  left  central  incisors,  lateral 
incisors,  canine  or  eye  teeth,  anterior  molars,  and  posterior  molars. 
The  incisors  and  canines  have  each  one  root  in  the  jaw,  the  lower 
molars  have  each  two  roots,  while  the  upper  molars  have  each  three 
roots. 

It  is  not  very  uncommon  to  observe  a  departure  from  the  usual 
order  of  the  eruption  of  the  teeth,  and  no  importance  is  to  be  attached 
to  irregularity  in  the  sequence  of  eruption,  if  average  progress  is  made 
as  regards  the  number  of  teeth  cut  at  different  stages  between  six 
months  and  two  years  of  age.  One  frequent  irregularity  is  the  appear¬ 
ance  of  the  anterior  molars  before  the  lateral  incisors  ;  another  common 
variety  from  the  usual  order  is  the  eruption  of  teeth  in  the  upper  jaw 
before  the  corresponding  teeth,  in  the  lower  jaw,  instead  of  some  little 
time  after.  A  much  more  vmfrequent  abnormality  is  the  absence  alto¬ 
gether  of  lateral  incisors,  sometimes  only  in  one  jaw,  sometimes  in 
both.  When  this  occurs,  the  central  incisors  are  generally  separated 
from  each  other  by  a  small  srps.ee,  as  if  apparently  to  occupy  as  well  as 
possible  the  space  in  the  gum  originally  intended  to  accommodate  four 
teeth. 

Development  of  Walking  Powers. — During  the  first  six  months 
of  its  life,  an  infant  has  practically  no  power  of  locomotion.  It  is  en¬ 
tirely  dependent  upon  its  mother  or  nurse  for  the  supply  of  its  wants, 
being  unable  even  to  approach  its  mother  to  seek  for  sustenance,  unless 
it  happens  to  be  lying  in  close  proximity  to  her.  This  inability  is  due 


CREEPING  AND  WALKING. 


ill 


probably  more  to  the  absence  of  intelligence  in  directing  the  muscles 
than  to  actual  weakness  of  the  muscles  themselves.  Immediately  after 
birth  an  infant  often  exhibits  considerable  muscular  strength,  grasping 
firmly  with  its  hands,  moving  its  arms,  and  kicking  or  curling  up  its 
legs.  But  for  some  months  it  is  unable  to  employ  this  muscular  power 
for  any  useful  purpose.  The  first  indication  of  a  growing  sense  of  the 
power  of  locomotion  is  usually  observed  in  the  baby  “  feeling  its  legs  ” 
when  taken  up  in  the  mother’s  arms.  If  held  under  the  arms  by  the 
mother  while  sitting  down,  a  baby  of  six  months  will  often  rest  its  feet 
on  its  mother’s  lap,  and,  when  encouraged,  will  place  one  foot  in  front 
of  another,  walking  as  it  were  toward  its  mother’s  face.  When  a 
month  or  two  older,  if  laid  on  the  floor,  and  tempted  by  any  article 
held  just  out  of  reach,  the  infant  will  usually  attempt  to  crawl  a  little 
on  its  hands  and  knees,  first  stretching  a  hand  out,  and  then  following 
with  one  leg  if  the  object  has  not  been  attained.  At  from  nine  to  ten 
months  of  age  many  infants  will  begin  to  try  to  stand  beside  a  chair  or 
sofa,  by  holding  which  they  can  assist  in  sustaining  themselves.  Hav¬ 
ing  attained  an  erect  posture  by  careful  adherence  to  the  chair,  the 
enterprising  infant  of  ten  months  will  cautiously  move  one  leg  after 
another  round  the  chair,  always  taking  care  to  maintain  its  hold  of  the 
friendly  support.  Continuing  to  educate  its  muscles  by  crawling,  by 
climbing  and  by  occasionally  falling  and  picking  itself  up  again,  in  the 
course  of  a  month  or  two  the  child  will  begin  to  walk  a  little  without 
support,  and  when  a  year  has  elapsed  from  birth  may  have  entered  on 
the  higher  sphere  of  existence  as  an  animal  possessed  of  locomotive 
powers.  Children,  however,  vary  much  in  the  age  at  which  they  first 
are  capable  of  walking  without  assistance  ;  some  will  not  attain  the 
faculty  until  they  are  eighteen  months  or  even  two  years  old,  while 
some  exceptionally  advanced  infants  will  walk  unassisted  when  they 
have  only  attained  the  age  of  ten  months.  There  is  no  reason  what¬ 
ever  to  be  anxious  about  any  moderate  delay  in  the  development  of 
walking  powers  in  an  infant,  if  in  all  other  respects  it  appears  quite 
healthy.  In  this  faculty  as  in  others  there  is  great  variety  among 
children  both  in  the  manner  and  the  rapidity  of  acquisition.  Some 
infants  never  pass  through  the  preliminary  stage  of  crawling,  learning 
to  walk,  by  clinging  to  the  legs  of  chairs  and  tables  or  by  assistance 
from  their  mothers  and  nurses,  without  ever  resorting  to  the  apparently 
more  simple  quadrupedal  method  of  progression.  Others  again,  appar¬ 
ently  preferring  the  crawling  to  the  walking  method,  will  persist  in 
employing  it  for  purposes  of  locomotion  for  some  months  after  they 
might  reasonably  be  expected  to  resort  to  the  more  advanced  and  intel¬ 
ligent  erect  posture.  At  the  age  of  two  years  every  healthy  child 
should  be  able  to  walk  with  steadiness  and  facility  ;  and  when  the 
power  of  walking  is  uot  developed  at  that  age,  the  possibility  of  the 


1 12 


NORMAL  DEVELOPMENT  OF  THE  CHILD. 


existence  of  some  physical  or  mental  defect  should  present  itself  to  the 
parents,  and  lead  them  to  obtain  competent  medical  advice  in  the 
matter. 

Speech. — The  acquirement  of  the  art  of  speech  usually  accom¬ 
panies  more  or  less  contemporaneously  the  development  of  the  facul¬ 
ty  of  walking.  At  from  four  to  six  months  old  many  babies  can 
articulate  distinctly  the  vowel  a,  which  is  the  most  easily  pronounced 
of  all  the  vowels  ;  and  when  one  or  two  months  older  the  addition  of 
one  of  the  labial  consonants,  b,  m,  n,  p  can  usually  be  effected.  It  is 
more  easy  for  the  infant  to  prefix  the  consonants  than  to  suffix  them, 
and  accordingly  the  words  pa,  ma,  na,  or  the  reduplication  of  these  in 
papa ,  mama,  and  nana,  precede  considerably  in  time  the  words  am  or 
an.  Other  single  words  of  one  syllable  are  gradually  added  to  the 
vocabulary,  which  usually  consists  of  a  considerable  number  of  words 
before  any  attempt  is  made  to  combine  them  in  a  short  sentence.  A 
child  of  one  year  old  can  generally  pronounce  a  few  words  of  one  sylla¬ 
ble,  but  is  rarely  able  to  combine  two  consecutive  syllables  in  one 
expression.  The  small  muscles  of  the  larynx  by  which  the  sounds  are 
produced  are  acquiring  slowly  and  laboriously  their  education,  just  as 
the  larger  muscles  of  the  leg  in  walking  ;  and  combined  movements  in 
both  cases  are  much  more  difficult  than  simple  ones.  Children  gener¬ 
ally  find  it  more  easy  to  pronounce  two  syllables  of  one  word  consecu¬ 
tively  than  two  words  of  one  syllable,  the  slight  rest  between  the  two 
words  seeming  to  necessitate  a  fresh  effect  which  is  not  required  when 
the  syllables  immediately  succeed  each  other.  By  the  age  of  eighteen 
months  most  infants  will  be  able  to  express  some  meaning  by  two  or 
three  short  words  spoken  consecutively ;  and  when  the  age  of  two 
years  has  been  reached  many  children  will  be  found  to  have  a  fair 
command  of  short  sentences.  But  the  variety  in  progress  in  this 
respect  in  different  children  is  quite  as  noticeable  as  in  their  walking 
efforts.  Some  infants  are  exceptionally  quick  in  the  attainment  of  lan¬ 
guage,  speaking  with  some  intelligence  at  the  early  age  of  eighteen 
months  ;  others  again  do  not  attain  to  much  command  of  speech  until 
they  have  completed  their  third  year.  It  is  rather  exceptional  to  find 
early  development  of  the  faculties  both  of  speech  and  of  walking  in  one 
infant ;  more  frequently  a  baby  who  is  forward  in  one  direction  is 
somewhat  backward  in  the  other.  When  the  health  of  the  child  is 
satisfactory,  and  evidence  of  intelligence  in  other  respects  apparent,  no 
anxiety  need  be  felt  about  any  backwardness  in  the  attainment  of 
speech,  if  the  sense  of  hearing  is  ascertained  to  be  sufficiently  acute. 
No  difficulty  presents  itself  in  doing  this  ;  a  baby  of  six  months  old,  if 
its  sense  of  hearing  is  perfect,  will  have  its  attention  attracted  by  the 
tone  of  a  bell  or  by  the  voice  of  its  mother,  and  will  show  the  fact  by 
its  expression  and  attitude. 


MENTAL  PROGRESS  OF  THE  CHILD. 


1 13 

Intelligence. — With  the  acquisition  of  the  power  of  speech  comes 
gradually  the  sens,e  of  the  meaning  of  the  words  pronounced.  Even 
before  the  child  can  itself  pronounce  the  words  ma  and  pa,  it  begins  to 
identify  their  sound  with  different  individuals,  and  other  words  when 
learned  are  associated  with  the  objects  to  which  they  apply.  The  sense 
of  number  can  usually  be  observed  in  infants  between  one  and  two 
years  old,  who  will  be  found  to  distinguish  between  small  numbers 
such  as  two  and  three  or  four,  and  who  may  themselves  be  able  to 
count  up  to  five  or  ten.  About  the  same  time  also  they  will  be  found 
able  to  distinguish  between  colors,  calling  them  by  their  proper  names, 
and  selecting  particular  colors  when  asked  to  do  so.  In  regard  to 
appreciation  of  music,  very  marked  differences  are  observed  in  young 
children.  Some  babies  at  a  very  early  age  will  exhibit  preferences  for 
particular  tunes,  and  will  at  the  age  of  two  years  be  found  to  identify 
airs  by  associating  them  with  names.  When  the  faculty  is  markedly 
developed,  children  from  two  to  three  years  old  will  not  unfrequently 
be  heard  to  sing  airs  quite  correctly.  On  the  other  hand,  many  chil¬ 
dren  equally  intelligent  in  other  respects  exhibit  no  appreciation  of 
differences  of  tune,  and  no  faculty  of  repeating  airs  even  at  a  much 
more  advanced  age.  On  the  whole,  it  must  be  admitted  that  the  devel¬ 
opment  of  the  musical  faculty  in  children,  as  perhaps  also  in  older 
people,  bears  no  apparent  relation  to  the  cultivation  of  the  intelligence 
generally.  From  the  end  of  the  third  until  the  sixth  year  of  life  the 
healthy  child  is  found  to  progress  rapidly  in  development  and  intelli¬ 
gence,  exercising  its  powers  of  observation,  and  storing  its  memory 
with  the  facts  conveyed  to  its  mind  by  its  various  senses.  At  this  age 
children  are  specially  receptive  and  acquisitive,  and  seldom  require  or 
bear  well  the  stimulus  of  regular  teaching.  The  observation  of  every¬ 
day  life,  the  information  conveyed  by  communication  with  older  people, 
and  the  restless  energy  in  finding  out  things  for  themselves  usually 
give  sufficient  occupation  for  the  brain,  which  is  apt  at  this  age  to 
resent  pressure,  and  to  suffer  from  any  undue  strain. 

Second  Dentition. — At  about  the  age  of  six  years  children  usually 
commence  to  develop  their  second  or  permanent  teeth.  The  first  of 
these  to  appear  are  four  double  teeth,  which  are  situated  immediately 
behind  the  posterior  molars  of  the  first  or  milk  set  of  teeth.  The  time 
of  their  appearance  is  very  irregular ;  sometimes  they  will  come 
through  the  gum  before  the  age  of  five  years  has  been  reached;  in 
other  children  their  advent  may  be  postponed  until  the  seventh  year 
has  been  completed.  In  most  cases  the  lower  ones  appear  first ;  not  un¬ 
frequently  there  may  be  an  interval  of  some  months  between  the  erup¬ 
tion  of  the  lower  ones  and  the  upper  ones.  They  are  known  as  the  first 
permanent  molar  teeth.  Following  these,  at  about  the  age  of  seven 
years,  the  permanent  central  incisors  push  their  way  through  the  gums. 


NORMAL  DEVELOPMENT  OF  THE  CHILD. 


1 14 

displacing  before  them  the  temporary  central  incisors,  and  causing 
them  to  drop  out.  The  process  of  removal  of  the  temporary  teeth  to 
make  room  for  the  permanent  ones  is  rather  interesting.  As  a  perma¬ 
nent  tooth  grows  toward  the  edge  of  the  gum,  it  pushes  against  the 
root  of  the  temporary  tooth  in  front  of  it,  and  causes  its  absorption. 
This  absorption  proceeds  to  such  an  extent  that  frequently  the  whole 
root  of  the  temporary  tooth  disappears,  nothing  being  left  of  the  tooth 
except  the  crown  adhering  to  the  surface  of  the  gum.  As  the  absorp¬ 
tion  of  the  root  progresses,  the  temporary  tooth  becomes  more  and 
more  loose,  and  when  the  process  is  completed  the  tooth  is  so  little 
attached  to  the  gum  that  it  may  be  displaced  entirely  by  a  slight  move¬ 
ment  of  the  tongue.  The  edge  of  the  tooth,  where  the  process  of  ab¬ 
sorption  has  ceased,  is  often  very  sharp,  and  from  this  frequently  the 
mistake  is  made  of  supposing  that  the  temporary  tooth  has  been 
broken  off,  leaving  its  root  in  the  gum.  This,  however,  is  never  the 
case,  except  from  actual  violence ;  in  all  cases  where  the  tooth  1ms 
become  loose  and  fallen  out,  it  results  from  the  absorption  of  the  root 
due  to  the  pressure  of  its  underlying  permanent  successors.  The  cen¬ 
tral  permanent  incisors  are  followed  in  about  a  year  by  the  lateral  per¬ 
manent  incisors;  and  these  again,  at  about  the  age  of  nine  years, 
by  the  successors  of  the  anterior  temporary  molars,  which  in  a 
permanent  set  are  not  molars,  but  are  known  as  the  first  bicuspid 
teeth.  About  a  year  afterward,  between  the  ninth  and  tenth 
years  of  life,  the  posterior  temporary  molars  are  succeeded  by  the 
second  bicuspid  teeth,  situated  immediately  behind  the  first  bicuspids, 
and  directly  in  front  of  the  first  permanent  molar  teeth.  These  bicus¬ 
pid  teeth  are  strong  teeth  with  a  somewhat  rigid  top,  and  a  single  root 
grooved  on  each  side,  indicating  as  it  were  a  tendency  to  become 
double.  In  the  eleventh  year  the  permanent  canine  or  eye  teeth  usually 
make  their  appearance.  They  are  very  large,  strong  teeth,  and  have  a 
marked  tendency  in  many  children  to  project  forward  from  the  gum  ; 
in  some  cases  actually  growing  almost  directly  outward.  The  upper 
canines  very  often  cut  through  the  gums  very  high  up,  and  grow 
downward  in  front  of  the  roots  of  the  temporary  canines  in  place  of 
pressing  against  their  roots  and  causing  absorption.  When  this  occurs, 
a  very  unsightly  projection  of  the  permanent  teeth  results,  and  it  be¬ 
comes  necessary  to  extract  the  temporary  teeth  to  allow  of  the  perma¬ 
nent  ones  falling  back  into  their  proper  places.  Something  of  the  same 
kind  happens  not  unfrequently  with  the  lower  canine  teeth,  and  meas¬ 
ures  have  to  be  resorted  to  to  regulate  their  position.  From  the  sit¬ 
uation  of  the  canine  teeth  at  the  angles  of  the  mouth,  the  personal 
appearance  and  expression  is  affected  more  by  them  than  by  any  of  the 
other  teeth  ;  and  during  their  development  the  propriety  of  consultin  £ 
a  dentist  as  to  their  regulation  will  often  present  itself.  Not  unfr*- 


THE  AGE  OF  PUBERTY. 


115 

quently  the  space  left  between  the  lateral  incisors  and  the  first  bicus¬ 
pids  is  insufficient  to  admit  of  the  canines  occupying  their  proper 
position,  and  some  measures  have  to  be  taken  to  afford  space  for  them, 
either  by  the  extraction  of  one  of  the  permanent  teeth,  or  by  the  appli¬ 
cation  of  some  mechanism  to  distend  the  jaw. 

During  the  twelfth  year  or  a  little  later  the  second  'permanent 
molars  usually  develop,  appearing  immediately  behind  the  first  molars. 
The  molar  teeth  of  the  permanent  set,  like  those  of  the  milk  set,  have 
a  broad  surface  suitable  for  grinding  food  ;  the  upper  ones  have  each 
three  roots,  while  the  lower  ones  have  only  two. 

The  teeth  which  come  last  of  all,  and  complete  the  permanent  set, 
are  the  wisdom  teeth.  They  are  most  irregular  in  the  time  of  their 
appearance,  sometimes  being  found  as  early  as  the  fourteenth  year, 
sometimes  not  coming  through  the  gum  until  the  thirtieth  year,  and 
occasionally  never  developing  at  all.  They  resemble  in  appearance  the 
molar  teeth,  behind  which  they  present  themselves,  but  are  smaller  and 
have  only  single  roots,  which,  however,  are  grooved  as  if  to  indicate  a 
tendency  to  separate,  in  the  upper  wisdom  teeth  into  three,  and  in  the 
lower  into  two  branches.  The  permanent  teeth  when  complete  will  be 
seen  to  number  twenty-eight,  made  up  of  right  and  left,  upper  and 
lower  central  incisors,  lateral  incisors,  canines,  first  bicuspids,  second 
bicuspids,  first  molars,  second  molars,  and  wisdom  teeth. 

Puberty. — In  describing  the  progress  and  development  of  children 
up  to  the  age  of  thirteen  years,  it  has  not  been  necessary  to  make  any 
marked  distinction  in  regard  to  sex.  Minor  differences  of  weight  and 
height  between  boys  and  girls  have  been  incidentally  referred  to,  but 
the  general  description  given  has  applied  equally  to  children  of  either 
sex.  About  the  age  of  thirteen  or  soon  afterward,  certain  conditions 
of  development  present  themselves,  which  necessitate  distinct  descrip¬ 
tion  as  they  occur  respectively  in  male  and  female  children.  These 
conditions  are  associated  with  the  attainment  of  what  is  technically 
known  as  the  age  of  puberty,  and  are  intimately  related  to  the  elabora¬ 
tion  of  the  sexual  functions. 

In  girls,  usually  between  the  thirteenth  and  fifteenth  year,  sometimes 
somewhat -earlier,  and  occasionally  later,  a  considerable  change  in  the 
figure  is  observed  to  occur.  The  bust  becomes  fuller  and  the  breasts 
more  prominent,  while  the  figure  generally  is  noticed  to  be  more 
rounded  and  matured.  Those  physical  changes,  together  with  the  de¬ 
velopment  of  the  hair  in  some  parts  of  the  body,  are  accompanied  or 
followed  soon  by  the  appearance  of  menstrual  discharge.  For  some 
months  before  this  appears  there  is  often  considerable  lassitude,  ten¬ 
dency  to  aching  of  the  back  at  intervals,  and  mental  unrest.  Frequently 
girls  are  at  this  period  of  their  lives  irritable,  nervous,  and  hysterical, 
and  the  condition  of  the  mind  is  often  peculiar  and  fanciful.  Some 


NORMAL  DEVELOPMENT  OF  THE  CHILD. 


1 16 

times  the  appearance  of  the  menstrual  discharge  is  preceded  by  bleed¬ 
ing  from  other  parts  of  the  body.  Bleeding  from  the  nose  is  common  ; 
from  the  lungs  in  the  form  of  expectoration  of  blood,  and  from  the 
stomach  it  is  not  so  usual,  but  yet  not  very  unfrequent.  Expectoration 
of  blood  is  apt  to  lead  to  the  suspicion  of  lung  disease  ;  but  when  it 
occurs  at  the  age  of  puberty,  before  menstruation  has  appeared,  or  co- 
iucidently  with  its  appearance,  there  may  be  no  indication  whatever  of 
disease  of  the  lung,  or  of  any  tendency  to  consumption.  If  such  expec¬ 
toration  recurred  two  or  three  times  at  intervals  of  about  a  month,  the 
presumption  would  be  very  strong  that  it  was  due  entirely  to  the 
increased  blood-pressure  resulting  from  the  development  of  the-  men 
strual  function.  After  the  first  occurrence  of  the  true  menstrual  dis¬ 
charge,  it  generally  appears  regularly  at  intervals  of  about  twenty-eight 
days.  It  is  not,  however,  at  all  uncommon  to  find  it  arrested  for  two 
or  three  months  after  the  first  appearance,  then  occurring  once  again, 
and  again  intermitting  for  one  or  two  months.  Irregularity  of  this 
kind  in  the  first  one  or  twTo  years  after  puberty  has  been  attained  should 
not  give  rise  to  any  anxiety,  and  does  not  call  forany  medical  treatment 
if  the  general  health  is  satisfactory.  At  this  period  of  life,  however, 
the  general  health  is  rather  apt  to  fail  from  slight  causes,  and  any 
departure  from  health  should  be  watched  carefully,  and  medical  advice 
obtained  when  necessary.  More  especially  at  this  age  a  condition  of 
poorness  of  blood  known  as  chlorosis  is  apt  to  develop,  evincing  itself  in 
pallor  of  the  face,  breathlessness  on  exertion,  lassitude,  and  depression. 

The  Amount  of  the  Menstrual  Discharge,  and  the  number 
of  days  during  which  it  continues  at  each  monthly  period,  vary  very 
considerably  in  different  girls.  What  would  be  considered  an  excessive 
amount  in  a  weak  and  anaemic  girl  might  be  quite  normal  and  health¬ 
ful  in  one  who  is  strong  and  robust.  The  only  way  to  judge  whether 
the  amount  is  excessive  or  not  is  by  the  effect  produced  on  the  gen¬ 
eral  health  of  the  individual.  The  menstrual  flow,  although  it  may  cause 
a  girl  to  be  somewhat  pale  and  languid  during  its  occurrence,  should 
not  leave  any  injurious  effect  on  the  health  after  it  has  ceased  ;  if  it 
does  so,  either  the  amount  is  excessive,  or  the  health  is  in  some  way 
impaired.  A  normal  menstrual  period  may  last  from  two  to  nine  days  ; 
generally  each  period  is  of  the  same  duration  in  the  same  individual. 
The  intervals  between  the  periods  are  also  usually  very  constant  in 
the  same  individual,  although  varying  to  some  extent  in  different  girls. 
The  most  usual  interval  is  twenty-eight  days,  counting  from  the  first 
appearance  of  one  menstrual  period  to  the  first  appearance  of  the  next. 
This  period  may  in  different  persons  be  curtailed  to  twenty-five  days, 
or  extended  to  thirty-two  days.  Any  interval  less  than  twenty-five  days 
should  be  considered  abnormal,  and  medical  advice  should  be  sought, 
as  ill  results  are  apt  to  follow  too  frequent  menstruation.  There  is  not 


THE  MENSTRUAL  FUNCTION. 


117 

the  same  risk  attached  to  an  unduly  lengthened  interval,  but  after  the 
flow  has  been  quite  regular  for  some  months,  any  arrest  for  a  month  or 
more  should  call  for  notice  and  medical  treatment. 

The  health  and  mental  condition  of  girls  at  this  period  of  life  de¬ 
mand  much  attention  from  their  mother  or  other  female4 guardians.  As 
the  age  of  puberty  approaches  it  is  proper  to  tell  girls  of  the  probable 
appearance  of  the  menstrual  flow,  and  to  give  them  some  indication  of 
its  character  and  meaning.  It  is  also  right  to  enjoin  upon  them  the 
necessity  of  care  of  their  health  during  the  menstrual  flow,  the  risk 
which  may  follow  any  undue  exposure  to  cold  or  any  severe  exertion 
during  that  period,  and  the  propriety  of  adopting  means  to  insure 
proper  cleanliness.  At  the  same  time,  it  should  be  pointed  out  to  them 
that  the  menstrual  flow’ is*  a  normal  physiological  process,  upon  the 
regularity  of  which  their  general  health  will  to  some  extent  depend, 
and  that  they  ought  not  to  be  ashamed  to  let  their  mothers  or  other 
advisers  know  of  any  irregularity  or  any  discomfort  which  may  attend 
its  appearance. 

A  certain  amount  of  discomfort  and  even  of  pain  is  a  not  very  un¬ 
frequent  accompaniment  of  the  menstrual  period,  and  this  may  be 
present  in  the  absence  of  any  disorder  of  health  or  local  disease  of  the 
womb.  A  great  deal  can  be  done  to  relieve  this  pain  by  the  use  of 
suitable  medicines,  and  by  the  rest  for  one  or  two  days  of  the  period  ; 
and  the  slight  self-sacrifice  which  may  be  involved  in  abstaining  from 
social  pleasures  during  the  first  one  or  tvro  days  of  menstruation 
accompanied  by  pain  will  be  amply  repaid  by  freedom  from  subse¬ 
quent  discomfort,  and  by  perfect  health  during  the  intervals.  At 
this  stage  of  a  girl’s  life  it  is  of  much  importance  that  attention  should 
be  paid  to  the  regular  action  of  the  bowels.  Constipation  is  a  common 
trouble  at  this  period  of  life,  and  is  a  frequent  cause  of  discomfort  and 
pain  during  menstruation.  Where  it  exists,  it  is  desirable  that  some 
laxative  medicine  such  as  compound  licorice  powder  or  confection  of 
senna  should  be  taken  nightly  for  two  or  three  days  before  the  period 
is  expected.  There  is  no  objection  to  mild  laxative  medicines,  such  as 
those  mentioned  above,  being  taken  even  during  the  menstrual  period, 
but  it  is  well  at  that  time  to  abstain  from  any  violent  purgative  medi¬ 
cines,  as  they  are  somewhat  apt  to  set  up  localized  inflammation. 

Caution. — Great  discretion  should  be  used  in  the  employment  of 
stimulants  for  the  relief  of  pain  during  menstruation.  While  un¬ 
doubtedly  in  many  cases  great  relief  is  given  by  their  employment, 
there  is  very  considerable  risk  of  the  habit  of  taking  stimulants  being 
acquired,  and  preference  should  always  be  given  to  the  application  of 
poultices,  or  flannels  wrung  out  of  warm  water,  to  rest,  and  to  sedative 
medicines  prescribed  by  the  medical  attendant.  In  a  few  cases  where 
pain  is  excessive  some  local  treatment  to  the  womb  during  the  interval 


1 1 8 


NORMAL  DEVELOPMENT  OF  THE  CHILD. 


of  menstruation  maj  be  necessary,  but  this  should  always  be  avoided  if 
possible,  [except  when  it  can  be  arranged  for  self  application,  as  in 
many  cases  it  may  be.] 

Mental  Conditions. — Girls  at  this  period  of  their  life  are  some¬ 
what  prone  to  manifestations  of  slight  mental  and  moral  disorder. 
Various  symptoms,  comprehended  under  the  general  application  of 
“hysteria” — such  as  unprovoked  fits  of  laughing  and  crying,  or  attacks 
of  seeming  fainting  and  convulsions — not  unfrequently  present  them¬ 
selves,  while  motiveless  acts  of  mischief,  unnatural  cravings  for  abnor¬ 
mal  food,  and  perverted  moral  ideas  are  occasionally  met  with.  When 
phenomena  such  as  these  appear,  much  judgment  as  well  as  patience  is 
required  on  the  part  of  the  natural  guardian  of  the  invalid.  Super¬ 
vision  must  be  exercised,  and  proper  moral  principles  inculcated,  at 
the  same  time  that  the  physical  health  is  properly  attended  to.  Judi¬ 
cious  occupation,  both  for  the  mind  and  body,  is  essential,  and  care 
should  be  taken  in  the  selection  of  healthy  literature,  as  well  as  in  the 
choice  of  suitable  companions  in  recreation.  It  is  at  this  age  that 
morbid  inclinations  related  to  the  development  of  sexual  instinct  occa¬ 
sionally  occur,  and  a  wise  mother  will  always  be  particularly  careful 
of  the  companions  her  daughters  may  choose  at  this  anxious  period  of 
their  life,  and  will  cautiously  avoid  the  possibility  of  their  receiving 
contamination  or  injury  from  lax  or  improper  associations. 

Mothers  should  keep  carefully  in  view  the  importance  of  prevent¬ 
ing  too  much  brain=work  during  this  period.  Valuable  as  is  that 
higher  education  now  offered  to  girls,  it  may  be  purchased  in  some 
cases  at  too  dear  a  price.  Let  a  mother  see  that  her  girls  receive  a  true 
education,  the  “drawing  out”  of  their  mental  faculties  by  gradual  and 
healthy  means,  and  let  her  discountenance  everything  that  savors  of 
“cramming.” 

The  changes  which  have  just  been  described  as  occurring  at  puberty 
in  girls  are  completed  usually  in  a  comparatively  short  space  of  time. 
Very  often  in  from  three  to  six  months  an  entire  change  both  in 
figure  and  in  character  will  be  effected,  and  the  girl  becomes  changed 
into  the  young  woman. 

In  boys  the  change  which  occurs  at  puberty  usually  progresses 
much  more  gradually,  and  generally  some  years  are  requisite  for  the 
complete  development  of  the  boy  into  the  young  man.  The  age  of 
puberty  is  reached  by  boys  rather  later  than  by  girls.  Most  commonly 
it  commences  in  boys  at  from  fourteen  to  fifteen  years  of  age.  The 
most  striking  feature  is  the  change  in  the  tone  of  voice,  which  becomes 
of  a  deeper  character  ;  and  this  is  accompanied  by  increased  size  of  the 
larynx,  where  the  voice  is  produced,  and  by  projection  of  that  part  of 
the  larynx  known  as  “Adam’s  apple.”  The  figure  gradually  becomes 
more  manly,  the  chest  becomes  broader,  and  hair  is  developed  ip 


PUBERTY  IN  BOYS. 


1 19 


various  parts  of  the  body.  At  this  age  boys  are  apt  to  manifest  various 
nervous  derangements,  as  well  as  slight  mental  peculiarities.  Twitching 
of  various  muscles,  both  of  the  face  and  of  other  parts  of  the  body,  is  com¬ 
mon,  and  spasmodic  winking  is  of  frequent  occurrence.  Among  mental 
eccentricities  the  most  usual  is  bashfulness,  accompanied  by  a  tendency  to 
blush  on  slight  provocation  ;  exceptional  sensitiveness  and  unwonted  ir¬ 
ritability  of  temper  are  also  observed.  The  physical  and  mental  altera¬ 
tions  are  coincident  with,  and  in  some  manner  related  to,  the  develop¬ 
ment  of  the  sexual  function,  and  care  in  the  selection  of  companions,  and 
supervision  as  to  the  employment  of  leisure,  are  specially  necessary  at  this 
stage  of  a  boy’s  life.  There  is  no  doubt  about  the  extreme  value  of 
physical  exercise  at  this  critical  period  ;  and  the  rule  which  exists  at 
most  public  schools  of  compelling  boys  to  take  their  part  in  foot  ball, 
cricket,  and  other  exercises,  unless  specially  exempted  by  medical 
order,  is  founded  on  a  wise  knowledge  of  the  constitutional  peculiari¬ 
ties  of  the  age  of  puberty. 

[The  advisability  of  early  instruction  of  youth  in  sexual  physiology, 
to  guard  against  the  prevalent  vices  of  this  age,  is  sufficiently  urged  in 
the  companion  volume  to  this.  Also  Dr.  Foote  has  prepared  in  “Science 
in  Story”  (including  Sexual  Physiology  for  the  Young),  a  useful  book 
for  children,  concerning  all  the  functions  of  the  body.  See  advertising 
pages.] 


CHAPTER  XII. 


General  Care  of  the  Child. 

Washing  of  Baby;  Temperature  of  Water;  Soaps;  Use  of  Oil;  Attention  to 
Cord;  Dress;  Necessity  of  avoiding  Pressure  or  Restraint;  Material  of 
Clothing;  Diapers;  Bassinette;  Objection  to  Baby  Sleeping  with  Mother; 
Desquamation  of  Skin;  Red-Gum;  Value  of  Fresh  Air;  Sunshine;  Daily 
Baths;  Value  of  Douching;  Out-Door  Exercise;  Carriage  in  Arms;  Bassin¬ 
ette  Perambulators;  Importance  of  Support  when  sitting  up;  Walking  in 
Open  Air;  Cultivation  of  Cleanly  Habits;  Selection  of  Clothing;  Unreliable¬ 
ness  of  Children’s  Sense  of  Temperature;  Indications  of  Insufficient  Cloth¬ 
ing;  Change  of  Underclothing  at  Night;  Importance  of  Looseness  of 
Clothing. 

Immediately  after  birth  it  is  usual  to  wash  the  new  born  infant 
carefully  and  thoroughly.  For  this  purpose  the  infant  bath  described 
in  Chapter  VII.  is  very  convenient  ;  in  its  absence,  an  ordinary  foot¬ 
bath  or  a  large  basin  may  be  employed.  The  vrater  used  should  be 
comfortably  warm  ;  an  experienced  nurse  can  decide  by  testing  with 
her  hand  the  proper  temperature,  but  one  not  experienced  would  do 
well  to  make  use  of  a  bath  thermometer,  regulating  the  temperature  of 
the  water  to  100°  F.  Any  kind  of  good  soap  may  be  employed.  Most 
nurses  have  their  favorite  soap,  which  they  may  have  asked  the  mother  to 
obtain  beforehand,  and  the  nurse’s  preference  in  this  matter  should  be 
respected.  For  the  first  ablution  after  birth  a  small  piece  of  new  flannel 
answers  better  than  a  sponge  ,  afterward  there  is  no  objection  to  the 
use  of  a  sponge  in  the  daily  bath  of  the  infant.  When  the  skin  is  much 
covered  with  the  white  sebaceous  matter  referred  to  in  the  previous 
chapter,  washing  is  facilitated  by  rubbing  the  child  first  all  over  with 
either  lard  or  vaseline  or  olive-oil,  which  is  washed  off  afterward  with 
soap  and  warm  water.  In  washing,  special  care  should  be  taken  to 
clean  thoroughly  the  folds  and  hollows  of  the  body,  such  as  the  arm- 
pits,  the  ears,  the  folds  of  the  thighs,  and  behind  the  knees.  If  any 
sebaceous  matter  is  left  in  these  folds  it  is  apt  to  decompose  and  set  up 
irritation  which  may  result  in  inflammation  and  even  ulceration  of 
the  skin.  [As  the  eyes  of  the  new-born  infant  are  very  sensitive  and 
the  substance  on  its  skin  may  be  very  irritating  it,  has  been  recom¬ 
mended  that  a  bandage  be  applied  about  the  child’s  head  and  eyes  in  a 

way  to  protect  them  during  the  first  bath,  as  illustrated  in  the  accom- 

120 


BABY’S  BATH 


'Pan  Faux, 


TREATMENT  OF  THE  UMBILICAL  CORD. 


1 2  I 


Fig.  20 


panying  cut.  It  is  a  simple  expedient,  and  one  which,  if  carefully  em¬ 
ployed,  is  likely  to  prevent  many  cases  of  “ophthalmia  neonatorum,” 
the  eye  inflammation  from  birth  which  has  been  a  common  cause  of 
blindness,  and  ought  not  to  be.] 

After  being  washed  thoroughly  the  infant  is  dried  carefully  with  a 
warm,  soft  towel,  and  then  powdered  with  some  harmless  absorbent 
powder,  such  as  powdered  starch,  violet  powder,  or  Fuller’s  earth. 

Before  commencing  to  dress  the  baby,  some  little  attention  has  to 
be  given  to  the  part  of  the  umbilical  cord 
attached  to  the  navel.  It  will  be  remembered 
that  after  the  infant  is  born  this  cord  is  tied  in 
two  places  and  cut  between  the  two  ligatures, 
one  part  of  the  cord  remaining  attached  to  the 
child  at  the  navel,  and  the  other  part  con¬ 
nected  with  the  after-birth.  As  the  umbilical 
cord  is  of  no  utility  after  birth,  it  is  usual  to 
cut  it  within  two  or  three  inches  of  its  attach¬ 
ment  to  the  infant,  leaving  just  enough  of  it 
to  admit  of  its  being  tended  properly  until  it 
drops  off.  This  usually  happens  in  about  five 
days  after  birth.  From  the  time  the  cord  is 
cut  it  gradually  shrinks  and  becomes  drier, 
and  begins  to  detach  itself  at  its  connection 
with  the  skin  round  the  navel ;  and  this  pro¬ 
cess  is  usually  completed  in  about  five  days, 
when  the  dry  and  stiffened  cord  falls  off 
altogether.  Sometimes,  instead  of  becom¬ 
ing  dry,  it  becomes  soft  and  putrid,  with  a  somewhat  disagreeable 
smell.  In  such  cases  there  is  often  a  little  unhealthy  ulceration  at  the 
line  of  its  separation  from  the  skin,  and  there  is  sometimes  left,  after 
the  cord  has  fallen  off,  a  small  ulcerating  and  projecting  surface  on  the 
navel,  discharging  a  thin  unhealthy  matter,  and  giving  rise  to  a  slight 
unpleasant  odor. 

The  most  important  point  with  reference  to  the  cord  in  a  new-born 
infant  is  to-be  certain  that  it  has  been  tied  so  efficiently  as  not  to  admit 
of  any  bleeding  from  its  cut  end.  Sometimes  a  very  thick  cord  may 
have  been  tied  quite  satisfactorily  before  being  cut,  but  when  cut  may 
shrink  so  that  the  ligature  becomes  a  little  loose,  and  allows  of  some 
oozing  of  blood  from  the  cut  end.  When  there  is  any  appearance  of 
this  there  should  be  no  hesitation  in  putting  on  another  ligature  at 
once.  The  cord  apparently  has  no  sensation,  and  a  piece  of  tape  or  a 
few  strands  of  silk  thread  or  cotton  may  be  tied  as  tightly  as  possible 
round  it  without  the  infliction  of  any  pain  upon  the  baby.  It  is  not 
well  to  use  a  single  thread  or  a  piece  of  thin  twine  for  this  purpose,  as, 


BANDAGED  EYES. 


122 


GENERAL  CARE  OF  THE  CHILD. 


when  the  cord  is  soft,  it  may  be  cut  entirely  through  by  the  single 
thread,  and  bleeding  again  recur  from  the  fresh  wmund.  If  twine  is 
used  at  all,  it  should  be  of  a  soft  and  coarse  kind.  If  there  is  no  oozing 
from  the  end  of  the  cord,  it  is  dusted  well  with  powder,  and  enfolded 
in  a  small  piece  of  linen.  The  most  convenient  way  of  doing  this  is  to 
take  a  piece  of  old  linen  (part  of  an  old  handkerchief  does  very  well) 
about  seven  inches  by  four  inches  in  size.  In  the  middle  of  this  a  small 
hole  about  the  size  of  a  shilling  is  cut,  the  cord  is  drawn  through  this 
hole,  and  laid  flat  on  the  stomach  of  the  child  above  the  navel,  with 
one  layer  of  the  linen  below  it,  and  the  other  covering  it.  The  sides  of 
the  piece  of  linen  are  then  enfolded  over  the  cord,  and  the  whole  kept 
in  its  place  by  the  flannel  binder,  which  is  put  on  loosely  round  the 
abdomen  of  the  infant.  The  piece  of  linen  ought  to  be  changed  every 
time  that  the  child  is  bathed,  great  care  being  taken  that  no  traction  is 
made  on  the  cord  in  bathing  or  drying  the  child.  If  the  cord  remains 
moist  and  becomes  putrid,  some  antiseptic  powder  should  be  used  in 
place  of  the  starch  or  Fuller’s  earth  ;  equal  parts  of  powdered  boracic 
acid  and  oxide  of  zinc  make  a  very  satisfactory  powder  for  this  pur¬ 
pose.  If  there  is  any  discharge  from  the  navel  after  the  separation  of 
the  cord,  the  small  ulcerating  surface  which  will  come  into  view  when 
the  folds  of  the  navel  are  stretched  a  little  should  be  dusted  twice  daily 
with  the  antiseptic  powder  just  mentioned  ;  if,  in  the  course  of  a  week, 
it  is  not  entirely  well,  the  attention  of  the  medical  adviser  should  be 
called  to  it.  [Sanitary  Powder,  No.  37,  is  applicable  for  this  purpose. 
See  page  1230.] 

In  dressing  a  baby  it  is  most  important  that  all  its  clothes 
should  be  perfectly  loose.  Some  nurses  have  an  idea  that  a  baby  re¬ 
quires  external  support  from  its  clothes,  and,  accordingly,  occasionally 
draw  the  binder  so  tightly  that  the  infant  is  unable  to  breathe  prop¬ 
erly.  This  view  is  entirely  erroneous,  and  the  practice  founded  upon 
it  very  injurious.  The  two  objects  of  the  binder  are  to  prevent  the 
remnant  of  the  cord  from  being  injured  by  movement,  and  to  maintain 
the  warmth  of  the  child,  and  both  these  objects  are  equally  well 
effected  by  a  loose  binder. 

As  few  pins  as  possible  should  be  used  in  fastening  the  clothing  of 
an  infant,  and  these  should  invariably  be  safety-pins.  Where  it  can  be 
done  conveniently,  stitching  should  always  be  employed  in  preference 
to  pins. 

Clothing :  Warmth. — Consistently  with  warmth,  the  clothing  of 
an  infant  should  always  be  as  light  and  as  simple  as  possible,  and 
should  be  porous,  so  as  to  admit  of  ventilation  to  the  skin.  Flannel 
and  merino  are  the  two  materials  which  best  fulfil  these  indications. 
Of  the  two,  merino  has  some  advantage,  but  flannel,  if  good  and  pure, 
is  quite  satisfactory. 


CLOTHING:  WARMTH. 


123 


It  is  important  that  the  arms  and  neck  of  a  baby  should  be  properly 
clothed,  as  well  as  the  body  and  legs.  The  arms  and  hands  of  an  infant 
are  particularly  liable  to  cold,  and  when  the  circulation  in  the  arms  is 
impeded  by  chill,  the  digestion  and  the  breathing  are  usually  effected 
secondarily.  Nurses  and  parents  are  apt  to  imagine  that  if  the  tempera¬ 
ture  of  the  room  is  comfortably  warm,  there  is  no  risk  of  the  arms  or  legs 
of  a  child  being  chilled  when  uncovered.  It  should  be  remembered,  how¬ 
ever,  that  while  the  temperature  of  even  a  warm  room  seldom  exceeds 
70°  F.,  the  temperature  of  an  infant’s  body  is  about  98  5°  F.,  a  differ¬ 
ence  of  28°.  Many  new-born  infants,  if  not  very  robust,  will  show  by 
blueness  of  the  hands  the  effects  of  the  arms  being  left  uncovered  even 
in  a  thoroughly  warmed  -room.  It  has  been  already  remarked  that 
warmth  is  even  more  essential  than  food  to  the  new-born  child,  and 
especially  is  this  the  case  with  infants  who  have  been  born  somewhat 
prematurely.  Often  their  one  chance  of  life  depends  upon  the  attention 
given  to  maintain  their  temperature.  So  important  is  this  that  when  a 
child  is  born  during  the  seventh  or  eighth  month  of  pregnancy,  and 
seems  very  feeble,  it  is  usual  for  some  days,  or  even  longer,  to  omit 
altogether  the  processes  of  washing  and  dressing,  and  to  keep  the  infant 
simply  rolled  in  sheets  of  cotton-wool,  with  nothing  except  its  face 
exposed  to  the  external  atmosphere.  A  feeble  infant  will  often  make 
progress  in  this  way,  the  cotton-wool  being  changed  as  frequently  as  is 
necessary  to  maintain  cleanliness. 

A  new-born  infant  is  of  course  unable  to  let  it  be  known  when  it  is 
about  to  pass  water,  or  when  its  bowels  are  about  to  act ;  and  provision 
is  made  to  prevent  the  soiling  of  its  clothes  by  these  actions  in  the  form 
of  diapers  wdiich  are  pinned  or  tied  on  to  receive  the  discharges.  Those 
diapers  ought  to  be  soft  and  as  absorbent  as  possible,  without  being  too 
cumbrous  or  warm.  The  best  material  for  them  is  Turkish  towelling  ; 
but  ordinary  linen  or  flannel  is  often  employed  for  the  purpose.  Sheets 
of  absorbent  cotton-wool,  incased  in  gauze,  have  recently  been  intro¬ 
duced  as  substitutes  for  diapers  ;  they  are  convenient,  but  occasionally 
are  objectionable  as  maintaining  too  much  heat.  Diapers  must  be 
changed  as  often  as  is  necessary  by  the  frequency  of  micturition  and 
the  action  of  the  bowels  ;  they  should  never  be  allowed  to  remain  on  a 
baby  when  wet  or  dirty.  Nurses  are  occasionally  careless  in  this 
respect,  and  the  neglect  results  in  redness  and  irritation  of  the  thighs 
and  abdomen  of  the  child,  and  in  considerable  discomfort.  This  red¬ 
ness  and  irritation  is  not  unfrequently  attributed  to  improper  wash¬ 
ing  of  the  diapers  with  soda  or  other  irritant,  but  the  explanation 
in  the  vast  majority  of  instances,  if  not  invariably,  is  negligence  in 
changing  as  frequently  as  necessary.  In  some  cases  it  is  true  that  an 
irritating  condition  of  the  urine  or  the  faeces  will  conduce  very  much 
to  the  production  of  this  inflammation  ;  but  the  irritating  secretions 


124 


GENERAL  CARE  OF  THE  CHILD. 

ought  not  to  be  allowed  to  remain  in  contact  with  the  skin  long  enough 
to  do  much  injury. 

Waterproof  sheeting  ought  never  to  be  applied  external  to  the 
diapers  ;  it  is  injurious  to  the  child  in  preventing  the  cutaneous  respir¬ 
ation,  and  acting  as  a  continuous  poultice  ;  and  is  only  of  use  in  con¬ 
cealing  the  necessity  for  frequent  changing,  and  thus  covering  the 
laxness  of  a  careless  nurse. 

The  Cradle. — Every  baby  should  have  a  cradle  or  bassinette  for 
itself,  and  should  not  be  put  to  sleep  at  night  by  the  side  of  its  mother. 
During  the  day  there  is  not  the  same  objection  to  the  baby  lying  at  the 
side  of  its  convalescing  mother.  At  that  time  she  is  awake,  and  able  to 
see  that  the  child  lies  comfortably,  that  it  gets  pure  air  to  breathe,  and 
that  it  is  nursed  only  at  proper  intervals.  At  night,  on  the  other  hand, 
the  mother  ought  to  be  asleep,  and  if  so  is  unable  to  attend  properly  to 
the  wants  of  the  child.  It  may  thus  have  its  head  covered  with  blan¬ 
kets,  and  breathe  all  through  the  night  impure  air  saturated  with 
secretions  from  its  mother’s  body  ;  or  it  may  be  turned  round  accident¬ 
ally  with  its  face  downward,  and  be  suffocated  from  inability  to 
breathe  properly.  Another  objection  to  babies  sleeping  in  the  same 
bed  with  their  mothers  is  that  they  thus  acquire  bad  habits  of  nursing. 
When  put  to  the  breast,  instead  of  exhausting  it  properly  and  com¬ 
pleting  its  meal,  the  baby  is  apt,  when  allowed  to  lie  all  night  with 
its  mother,  to  play  with  the  breast,  taking  a  little  milk  occasionally, 
then  stopping  for  awhile,  and  again  resuming  the  process  of  sucking. 
Often  it  will  continue  this  for  the  greater  part  of  the  night,  soon  ac¬ 
quiring  the  habit  of  continuing  to  suck  even  when  more  than  half 
asleep.  In  this  way  it  obtains  more  milk  than  is  good  for  it,  deranges 
its  digestion,  and  at  the  same  time  unduly  exhausts  its  mother,  wTho 
wakens  in  the  morning  unrefreshed  and  wearied.  When,  on  the  other 
hand,  the  baby  sleeps  in  its  own  cradle,  it  is  taken  to  its  mother  when 
it  cries  for  food,  exhausts  the  breast,  is  replaced  in  its  cradle,  and 
sleeps  quietly  until  again  awakened  by  the  cravings  of  hunger.  It  is 
only  when  a  baby  is  very  feeble  and  in  great  want  of  warmth  that  it  is 
right  to  allow  it  to  share  its  mother’s  bed.  In  such  cases  the  animal 
warmth  of  the  mother  is  very  valuable,  and  she  soon  instinctively 
acquires  the  faculty  of  taking  care  of  the  infant  even  during  her  sleep, 
often  sleeping  for  hours  at  a  time,  with  the  infant  in  her  arms,  without 
making  any  alteration  in  her  position  to  the  injury  of  the  child.  Here 
the  risk  of  the  infant  acquiring  bad  habits  of  nursing  does  not  present 
itself,  as  feeble  infants  seldom  or  never  exceed  in  the  amount  of  milk 
they  draw  from  the  breast  ;  the  difficulty  is  usually  the  opposite  one 
of  inducing  them  to  take  enough,  and  the  importance  of  warmth  so 
transcends  any  other  requirement  that  everything  else  has  to  be  sacri¬ 
ficed  for  that  one  object. 


FRESH  AIR  ESSENTIAL. 


125 


The  Skin. — During  the  first  few  weeks  of  life  every  baby  sheds  its 
external  skin.  Sometimes  this  process  of  desquamation,  as  it  is  called, 
is  effected  rapidly,  the  skin  coming  off  in  large  scales,  or  even  in  shreds, 
and  the  shedding  being  completed  within  less  than  a  week  from  its 
commencement.  In  other  cases  the  desquamation  progresses  slowly 
and  almost  invisibly,  only  a  little  roughness  of  the  skin  being  occasion¬ 
ally  noted,  and  perhaps  a  few  loose  scales  detected  here  and  there. 
Not  unfrequently  some  irritation  of  the  skin  accompanies  the  desquam¬ 
ation,  and  it  may  be  characterized  by  small  red  pimples  scattered  over 
the  body,  to  which  the  name  of  red  gum  is  usually  applied.  In  cases 
of  rapid  desquamation  little  patches  of  old  skin  sometimes  become  ele¬ 
vated  so  as  to  resemble  vesicles,  containing  occasionally  a  little  fluid, 
just  like  the  vesicles  of  chicken-pox.  This  irritation  of  the  skin  seldom 
is  sufficiently  serious  to  call  for  any  attention.  A  little  additional  care 
in  drying  the  child,  so  that  the  towel  may  not  irritate  any  pimples  or 
vesicles,  is  desirable,  but  beyond  that  nothing  is  necessary,  and  it  will 
be  invariably  found  that  the  eruption  subsides  after  a  few  days,  and 
leaves  the  new  skin  soft  and  smooth  underneath. 

Value  of  Fresh  Air. — In  addition  to  warmth,  young  infants, 
even  more  than  older  children,  are  very  dependent  for  their  health  and 
growth  upon  a  proper  supply  of  fresh  air.  Even  in  strong  children 
the  power  of  breathing  deeply  is  comparatively  feeble  in  very  early 
life,  and  it  is  most  important  that  the  air  they  inhale  in  breathing 
should  be  the  purest  obtainable.  If  the  bodies  of  babies  are  kept  thor¬ 
oughly  warm,  there  is  very  little  risk  of  their  catching  cold  from  in¬ 
spiring  cold  air.  Healthy  babies  naturally  breathe  always  through  the 
nose,  keeping  their  mouths  shut,  and  cold  air  is  warmed  by  contact  with 
'.he  interior  of  the  nose  before  it  reaches  the  more  sensitive  linings  of 
the  throat  and  bronchial  tubes.  Even  in  winter  a  strong  baby  can 
be  safely  taken  out  of  doors  in  the  arms  of  its  nurse  within  three  or 
four  weeks  of  its  birth  if  the  weather  is  bright  and  free  from  cold  or 
damp  winds.  It  is  usual  and  judicious  at  first  to  accustom  the  baby  to 
changes  of  temperature  by  taking  it  from  one  room  to  another  ;  and 
when  it  has  been  thus  used  to  comparatively  slight  changes,  it  may  be 
taken  out  of  doors  for  a  short  period  at  a  time.  It  is  important  to  note 
that  it  is  much  more  the  duration  of  exposure  to  cold  than  the  intensity 
of  cold  which  is  likely  to  injure  a  young  infant.  All  babies,  even 
weakly  ones,  have  a  certain  power  of  resisting  the  influence  of  cold, 
but  when  the  power  is  feeble  it  is  very  early  exhausted,  and  then  bad 
results  ensue.  Exposure  to  cold  air  in  babies  has  much  the  same  effect 
on  them  as  indulgence  in  cold  baths  on  adults.  While  as  short  expos¬ 
ure  is  stimulating  and  healthful  in  its  effects,  prolonged  exposure  to 
cold  is  followed  by  depression,  coldness  of  the  extremities,  and  ten¬ 
dency  to  catarrh  of  the  bronchial  tubes  or  of  the  stomach  and  bowels. 


126 


GENERAL  CARE  OF  THE  CHILD. 


The  effects  of  cold  air  must  be  watched  by  the  nurse  or  mother  when 
carrying  the  infant,  and  it  must  be  taken  indoors  when  the  hands  or 
feet  are  felt  to  be  in  the  least  chilly.  When  due  regard  is  paid  to  the 
maintenance  of  warmth,  nothing  is  more  beneficial  to  young  children 
than  regular  exposure  to  the  open  air.  The  appetite  is  found  to  in¬ 
crease  and  the  color  of  the  infant  to  improve,  more  rapid  progress  is 
made  in  growth,  and  the  sleep  at  night  is  better  and  less  disturbed. 

After  the  first  few  days  of  life  a  baby  of  normal  strength  may  be 
carried  from  one  room  to  another  ;  and  in  summer,  when  from  a  week 
to  a  fortnight  old,  may  be  taken  into  the  open  air  for  fifteen  or  twenty 
minutes  at  a  time.  In  winter  it  is  generally  safer  to  keep  the  baby 
indoors  until  it  has  attained  the  age  of  three  weeks  to  a  month,  and 
then  to  take  it  outdoors  only  when  the  weather  is  fine,  and  when  there 
is  not  much  wind.  After  the  outdoor  exercise  has  once  been  com¬ 
menced  it  should  be  continued  as  regularly  as  the  weather  will  permit, 
the  duration  of  the  exposure  to  the  open  air  being  gradually  increased 
until  the  baby  spends  three  or  four  hours  daily  or  even  more  in  the 
fresh  external  air.  For  the  first  three  months  of  their  life,  at  least, 
babies  ought  to  be  carried  in  the  arms  of  their  mother  or  nurse  when 
taken  out.  They  are  more  comfortable  in  the  support  given  them  by 
the  arms  of  the  person  carrying  them  than  they  can  be  in  any  peram¬ 
bulator,  and  they  have  the  great  additional  advantage  of  being  kept 
warm  by  the  close  contact  with  another  human  body.  It  is,  however, 
now  usual  to  put  them  into  bassinette  perambulators  when  they  have 
attained  the  age  of  about  three  months.  A  bassinette  perambulator  is 
not  in  any  way  objectionable  for  a  young  baby,  if  due  care  be  taken 
that  it  lies  properly  in  it,  and  that  it  is  maintained  in  due  warmth.  The 
advantage  of  the  nurse’s  arms  is  that  there  more  stimulus  is  given  to 
the  muscular  system  of  the  infant,  and  its  growth  is  thereby  promoted. 
But  a  baby  generally  is  carried  about  sufficiently  within  the  house  to 
gain  advantage  in  this  way  ;  and  the  bassinette  perambulator,  on  the 
other  hand,  has  the  merit  of  allowing  the  infant  to  be  longer  in  the 
open  air,  as  the  nurse  does  not  become  fatigued  in  wheeling  it  as  she 
does  when  carrying  the  child  in  her  arms. 

Bassinette  perambulators  are  usually  constructed  with  a  well  in  the 
centre,  covered  over  with  a  padded  board.  When  the  baby  reaches  the 
age  of  six  to  eight  months,  it  will  probably  object  to  the  horizontal 
position,  and  the  board  will  have  to  be  removed  to  allow  of  the  child 
sitting  up.  When  this  stage  is  attained,  care  must  be  taken  that  the 
back  is  properly  supported,  cushions  being  used  for  that  purpose  when 
necessary,  and  that  the  feet  are  kept  warm,  and  have  something  to  rest 
on  if  the  well  is  too  deep  for  them  to  reach  to  the  floor.  The  baby 
should  also  be  suppprted  at  the  side,  if  the  perambulator  is  a  wide  one, 
so  fis  not  put  any  undue  strain  upon  the  still  rather  weak  muscles 


SUNSHINE  :  BATHING. 


127 


of  the  back.  When  the  child  has  attained  the  faculty  of  walking 
fairly  well,  perhaps  about  the  age  of  eighteen  months,  it  should  be 
taken  out  of  its  perambulator  for  a  short  time  every  day  and  permitted 
to  walk  a  little  in  the  open  air.  Gradually  the  length  of  the  walk  may 
be  increased,  and  when  the  child  has  arrived  at  the  age  of  two  and  a 
half  to  three  years,  the  perambulator  may  be  dispensed  with  entirely, 
it  is  not  well,  however,  to  dispense  with  this  means  of  locomotion  too 
early.  It  is  most  important  that  the  young  child  should  spend  a  con¬ 
siderable  part  of  its  time  in  the  open  air,  but  at  the  same  time  it  is  of 
equal  importance  that  it  should  not  be  unduly  fatigued  by  walking, 
and  the  perambulator  should  accordingly  be  used  until  the  walking 
powers  are  fairly  matured.  It  will  often  be  found  advisable  to  allow 
the  child  for  some  time  to  walk  during  the  forenoon,  and  to  be  driven 
in  the  perambulator  in  the  afternoon,  before  discarding  its  use  alto¬ 
gether.  As  an  aid  to  outdoor  exercise,  the  recently  introduced  chil¬ 
dren’s  mail-carts  are  of  much  value,  but  they  are  unsuitable  for  chil¬ 
dren  under  the  age  of  one  year. 

Value  of  Sunshine. — Another  important,  element  in  promoting 
the  vigor  of  the  young  infant  is  a  due  amount  of  sunshine.  So  far  as 
possible,  the  room  in  which  the  baby  spends  the  greater  part  of  its 
time  should  be  one  which  admits  as  much  sunlight  as  possible.  The 
influence  of  the  sun  in  whatever  way  it  may  act,  is  as  beneficial  to  the 
life  of  an  infant  as  it  is  necessary  to  the  life  of  most  plants.  It  is  erro¬ 
neous  to  suppose  that  the  eyes  of  a  baby  may  be  injured  by  exposure  to 
bright  light.  As  soon  as  a  baby  is  old  enough  to  express  pleasure  by 
signs,  it  will  show  its  appreciation  of  brightness,  and  its  eyes  are  cer¬ 
tainly  not  more  sensitive  than  the  eyes  of  any  ordinary  adult,  or  more 
likely  to  be  injured  by  sunlight. 

The  Bath. — For  the  first  two  or  three  months  of  a  baby’s  life  it 
should  be  bathed  every  morning  in  water  of  the  temperature  of  100° 
F.  After  it  lias  attained  the  age  of  three  months,  the  morning  bath 
should  be  cooled  gradually,  reducing  it  by  about  5°  F.  weekly,  until  a 
temperature  of  70°  F.  is  attained.  In  winter  the  temperature  of  the 
bath  should  not  be  reduced  below  this  degree,  but  in  summer  it  may  be 
reduced  until  a  quite  cold  bath  is  given,  which  in  summer  represents  a 
temperature  of  about  60°  F.  Some  attention  must  be  paid  to  the  pre¬ 
dilections  of  the  baby  in  the  matter.  Some  babies  enjoy  thoroughly 
the  coolness  of  the  bath,  and  are  obviously  made  brighter  and  benefited 
by  it ;  others  again  resent  the  diminished  temperature,  and  cry  when 
put  into  it.  When  this  occurs,  the  temperature  must  be  raised  again  to 
that  preferred  by  the  infant,  and  more  gradual  attempts  made  to  slowly 
diminish  it.  Sometimes,  if  a  baby  resents  any  diminution  in  the  tem¬ 
perature  of  the  bath,  it  will  not  object  to  a  little  douching  with  cooler 
water  when  sitting  in  the  warm  water.  This  douching  has  a  very 


128 


GENERAL  CARE  OF  THE  CHILD. 


stimulating  effect,  and  is  very  simply  carried  out.  As  the  baby  sits  in 
its  bath,  the  nurse  pours  some  cool  water  from  a  jug  held  in  her  hand 
down  the  back  of  the  child,  letting  it  fall  just  below  the  neck  and  run 
downward  into  the  bath.  As  the  baby  becomes  somewhat  accustomed 
to  it,  the  jug  is  held  somewhat  higher ;  and  if  at  first  tepid  water  is 
used,  and  gradually  day  by  day  more  cold  water  is  added  until  water 
entirely  cold  is  employed  for  the  douche,  and  the  height  at  which  the 
jug  is  held  gradually  increased,  a  baby  will  be  found  to  thoroughly 
enjoy  a  cold  douche  on  its  back  from  a  height  of  two  or  three  feet. 
The  great  art  in  inducing  babies  to  undergo  the  little  shock  involved  in 
entering  a  cold  bath  or  in  being  douched  is  never  under  any  circum¬ 
stances  to  frighten  or  startle  them.  Everything  must  be  done  gently, 
quietly,  and  gradually ;  and  a  baby  five  to  six  months  old  can  easily 
be  led  to  regard  the  whole  process  as  a  part  of  its  daily  amusement. 
The  tepid  or  cold  douche  can  often  be  used  with  advantage  to  babies 
who  are  not  strong  enough  to  bear  a  cold  bath,  and  it  may  be  continued 
throughout  the  whole  winter,  as  well  as  in  the  summer.  An  evening  bath 
should  always  be  a  comparatively  warm  one,  although  it  is  not  neces¬ 
sary  to  maintain  it  at  the  temperature  used  immediately  after  birth. 
Speaking  generally,  it  should  not  be  allowed  to  fall  below  a  tempera¬ 
ture  of  85°  F.,  while  90°  F.  to  95°  F.  will  usually  be  more  eligible. 
The  exact  temperature  should  be  decided  mainly  by  the  influence  the 
bath  may  have  in  inducing  quiet  sleep.  [The  author  exhibits  the 
English  fondness  for  cold  bathing  and  douching,  and  however  hygienic 
it  may  be  for  the  hearty  child  in  its  “teens”  or  the  robust  adult,  our 
idea  is  that  the  mother  should  “go  slow”  in  the  effort  to  cultivate  a 
fondness  for  it  in  babies.  The  artistic  picture  at  the  opening  of  this 
chapter  is  called  the  Baby’s  Battle,  but  if  the  baby’s  own  feelings  are 
duly  respected  as  to  temperature,  it  should  rather  be  the  Baby’s 
Delight.] 

Cleanly  Habits. — It  is  very  important  for  the  comfort  both  of  the 
mother  and  the  child  to  inculcate  as  early  as  possible  the  propriety  of 
cleanly  habits.  For  the  first  two  or  three  months  of  life  the  baby 
discharges  the  excretions  from  the  kidneys  and  bowels  almost  involun¬ 
tarily,  and  gives  no  indication  when  these  discharges  are  about  to 
occur.  For  this  reason  it  is  necessary  always  to  have  a  diaper  adjusted 
to  receive  them.  After  the  first  two  or  three  mouths  the  infant  is  con¬ 
scious  of  their  occurrence,  and  the  mother  or  nurse  should  attempt  to 
associate  it  regularly,  morning  and  evening,  and  at  other  times,  in  the 
baby’s  mind  with  some  sound. 

When  the  association  has  been  fully  perceived  by  the  infant,  it  will 
soon  progress  a  step  farther,  and  give  notice  to  the  mother  or  nurse 
when  an  action  is  about  to  take  place,  by  making  the  same  sound 
itself.  For  the  first  few  months  of  life  the  voluntary  control  of  the 


CLOTHING  FOR  OLDER  CHILDREN. 


129 


actions  of  micturition  and  defecation  is  feeble,  but  this  control  is  in¬ 
creased  and  educated  by  the  child  itself  when  it  learns  to  give  notice  of 
its  desire  for  relief.  Children  vary  much  in  the  rapidity  with  which 
they  learn  this  important  lesson,  but  it  is  not  at  all  unusual  to  find 
children  of  only  six  months  old  who  can  be  safely  left  without  any 
diaper  during  the  whole  day.  At  night  the  sensitiveness  of  the  child 
to  warnings  is  diminished,  and  it  is  usually  necessary  to  continue  the 
employment  of  diapers  throughout  the  night  during  at  least  the  whole 
of  the  first  year  of  life.  After  six  months  of  age,  the  infant,  instead  of 
being  held  out  by  the  nurse,  can  be  placed  upon  a  low  night-stool, 
night  and  morning,  supported,  if  necessary  at  first,  by  its  nurse.  The 
encouragement  thus  given  to  one  or  more  daily  actions  of  the  bowels  at 
regular  hours  induces  a  habit  which  is  of  much  value  in  maintaining 
the  health  in  later  years.  The  solicitation  of  an  action  of  the  bowels  in 
this  way  should  be  continued  daily  throughout  childhood,  and  should 
be  attended  to  as  nearly  as  possible  at  the  same  hour  every  morning, 
and  due  care  should  be  taken  that  a  sufficient  time  is  allotted  to  the 
purpose. 

In  the  Selection  of  Clothing  for  Older  Children  three  points 
ought  to  be  kept  in  view  :  the  first  that  the  clothes  are  of  such  material 
and  shape  as  to  fulfil  well  their  function  of  keeping  the  body,  and  more 
especially  the  arms  and  legs,  warm  ;  the  second,  that  they  interfere  as 
little  as  possible  with  freedom  of  movement  ;  and  the  third,  that  they 
are  as  light  as  possible  in  weight  consistently  with  fulfilling  their  first 
and  most  important  end.  For  both  night  and  day  wear  the  garments 
next  the  skin  should  be  of  soft,  porous,  and  absorbent  material,  and 
should  be  capable  of  being  washed  frequently  without  injury  to  the 
texture.  The  materials  which  answer  these  conditions  best  are  merino, 
flannel,  and  woven  silk,  the  first  named  being  the  preferable.  No 
underclothing  for  day  use  is  so  satisfactory  for  children’s  use  as  merino 
combinations,  which  should  always  have  long  arms  reaching  to  the 
wrists,  high  necks,  and  legs  coining  down  below  the  knees  in  winter, 
and  reaching  almost  to  the  knees  in  summer.  These  combinations  are 
now  made  in  varying  thicknesses  of  merino,  and  in  all  sizes,  from  those 
suitable  to  Children  of  a  year  old  to  those  intended  for  adults  ;  they  are 
not  expensive,  and,  if  the  material  is  good,  they  last  well  when  prop¬ 
erly  taken  care  of.  With  underclothing  of  this  kind,  and  of  a  thick¬ 
ness  suitable  to  the  season  and  prevailing  temperature,  almost  any  vari¬ 
ation  may  be  made  in  the  external  clothing  according  to  the  taste  of  the 
mother  without  risk  from  cold.  In  judging  of  the  sufficiency  of  a 
child’s  clothing,  very  little  reliance  can  be  placed  on  its  own  sensations, 
and  the  mother  must  judge  for  herself  by  the  temperature  of  the  hands 
and  feet  of  the  child.  It  is  rare  for  a  healthy  child  to  complain  of  cold 

even  when  suffering  much  from  insufficient  clothing  ;  but  if  a  child  in 

5 


130 


GENERAL  CARE  OF  THE  CHILD. 


good  health  comes  in  from  a  walk  or  from  a  ride  in  a  perambulator 
with  hands  and  feet  cold  and  pale  or  blue  on  the  surface,  it  may  be 
assumed  that  in  some  particular  direction  the  clothing  is  insufficient, 
and  most  often  it  will  be  found  to  be  the  covering  of  the  arms  or  of  the 
legs  which  is  deficient.  Very  frequently  the  arms  and  legs  will  be 
found  cold  when  the  body  is  quite  warm,  but  the  body  will  never  be 
observed  to  be  cold  when  the  arms  and  legs  are  warm.  The  influence 
of  cold  of  the  extremities  in  affecting  adversely  the  digestion  has 
already  been  referred  to,  and  many  of  the  other  catarrhal  troubles  of 
childhood  flow  from  the  same  cause.  A  very  common  mistake  made 
in  this  country  is  to  assume  that  there  is  no  risk  of  a  child  suffering 
from  cold  when  indoors.  Many  parents  who  take  the  greatest  care  to 
clothe  their  children  warmly  when  going  out  of  doors  allow  them  when 
indoors  to  have  both  arms  and  legs  uncovered,  and  to  be  insufficiently 
clothed  in  other  respects.  With  a  changeable  climate  like  that  of 
England,  [or  the  United  States]  there  is  considerable  risk  in  doing 
this,  unless  the  temperature  is  carefully  regulated.  Many  cases  of 
depressed  health  in  children  without  any  very  ddined  cause  are  due  to 
the  influence  of  cold  from  insufficient  clothing,  and  it  is  probable  that 
the  great  frequency  of  rheumatism  in  children  in  this  country  is  due 
much  more  to  the  depressing  effect  of  insufficient  clothing,  acting 
through  a  long  period  of  time,  than  to  the  occasional  exposure  to  severe 
chill. 

For  the  night  wear  of  children  flannel  night-dresses  are  very  suita¬ 
ble,  and  are  perhaps  more  convenient  than  merino  combinations. 
Merino  night-dresses  also  have  been  introduced  within  late  years,  and 
are  exceedingly  comfortable  and  warm.  Young  children  are  very  apt 
to  kick  their  legs  out  of  the  night-dress  during  sleep,  and  run  a  risk  of 
chill  in  this  way  ;  in  order  to  prevent  this,  it  is  often  well  to  have  the 
flannel  or  merino  night-dress  made  about  a  foot  longer  than  the  child, 
and  to  double  the  bottom  over,  and  pin  it  with  a  safety-pin  when  the 
child  lies  down  in  bed,  thus  enclosing  the  feet  as  it  were  in  a  bag. 

It  is  almost  needless  to  add  that  no  child  should  ever  wear  the 
same  clothes  next  the  skin  during  the  night  which  it  has  wTorn  during 
the  previous  day.  When  confined  to  bed  by  illness,  the  night-dress 
should  always  be  changed  night  and  morning,  and  should  always  be 
well  aired  before  being  put  on,  in  winter  in  front  of  a  fire,  and  in  sum¬ 
mer  by  being  hung  up  in  a  dry  and  airy  room. 

Children  now  practically  never  wear  night-caps,  although  forty 
years  ago  their  use  was  universal ;  and  they  never  suffer  in  any  way 
from  their  absence.  This  is  due  to  the  fact  that  the  strength  of  the 
circulation  in  the  head  is  greater  than  in  any  other  part  of  the  body. 
Cold  m  the  head  is  never  due  to  cold  on,  the  head  ;  it  is  invariably  the 
result  of  chill  in  some  other  reirion. 

O 


CLOTHING  SHOULD  NOT  BIND. 


I3i 

Caution. — Care  should  be  taken  that  the  clothes  of  children  never 
press  unduly  on  any  part  of  the  body  so  as  to  interfere  with  the  respira¬ 
tion  or  circulation.  Pressure  on  the  waists  of  children  must  be  espec¬ 
ially  avoided,  and  all  weight  of  clothes  should  be  borne  by  the 
shoulders,  being  supported  either  by  braces  or  by  loose  stays  attached 
to  shoulder  bands.  Garters  to  support  stockings  exercise  an  injurious 
influence  on  the  circulation  of  the  legs  ;  stockings  ought  to  be  sup¬ 
ported  by  elastic  suspenders,  attached  at  their  upper  end  to  stays 
supported  from  the  shoulders,  or  to  a  very  loose  waist-belt. 

The  same  principles  which  have  been  mentioned  in  reference  to  the 
clothing  of  children  are  equally  applicable  to  the  dress  of  later  youth. 
In  girls  merino  combinations  should  be  worn  during  the  day  through¬ 
out  the  period  of  puberty,  an  age  at  which  any  insufficiency  of  clothing 
is  apt  to  have  specially  prejudicial  results.  Flannel  or  merino  should 
also  be  employed  for  the  night-dress.  In  boys,  during  the  day,  merino 
jerseys  and  pants  maybe  substituted  for  combinations  ;  and  for  clothing 
during  the  night  by  far  the  most  eligible  is  the  costume  so  universally 
used  in  the  East  by  Europeans,  consisting  of  thin  flannel  pajamas  and 
light  flannel  coat. 

Some  attention  should  be  given  to  the  boots  and  shoes  worn  by 
children  after  they  commence  to  walk.  If  their  feet  are  to  develop 
well,  it  is  important  that  they  should  not  be  compressed  in  any  direc¬ 
tion  by  their  coverings.  Many  bootmakers  invariably  measure  the  feet 
wdien  suspended  in  the  air,  overlooking  the  fact  that  when  the  foot  is 
pressed  on  the  ground  it  expands  considerably  in  width.  The  result  is 
that  the  boot  is  made  too  narrow  in  the  sole,  and  the  foot  is  compressed 
laterally,  and  consequently  loses  much  of  its  elasticity.  A  boot  or  shoe 
should  always  be  made  wide  enough  in  the  sole  to  allow  the  foot  to 
expand  to  its  full  extent  without  incurring  any  lateral  compression.  If 
this  is  not  attended  to,  not  only  do  corns  develop,  but  the  toes  become 
compressed  and  crowded,  and  a  bad  style  of  walking  is  acquired.  A 
similar  result  follows  the  wearing  of  inordinately  high  heels,  which 
cause  the  foot  to  slip  forwards  within  the  boot,  resulting  in  compres¬ 
sion  and  malformation  of  the  toes.  The  interior  of  a  boot  or  shoe 
should  conform  to  the  natural  sole  of  the  foot,  and  the  surface  for  the 
heel  should  be  on  a  level  with  the  surface  for  the  ball  of  the  great  toe. 
If  this  and  the  due  breadth  are  attended  to,  it  is  a  matter  of  small  im¬ 
portance  whether  a  shoe  or  boot  is  worn,  or  whether  the  boot  be  laced, 
buttoned,  or  spring-sided.  When  spring  sides  are  used,  however,  care 
should  be  taken  that  the  pressure  is  not  great,  and  that  it  is  equally 
distributed  over  the  foot,  not  concentrated  in  a  ring  round  the  ankle. 

[How  to  Dress  the  Baby. — In  a  pamphlet  with  this  title  Mrs. 
Susan  T.  Converse  has  criticised  the  usual  mode  of  dressing  a  baby, 
anti  suggested  what  she  regards  as  a  far  better  plan.  Instead  of  merely, 


132 


GENERAL  CAKE  OF  THE  CHILD. 


referring  the  reader  to  this  pamphlet  (issued  at  ten  cents  by  the  Murray 


Hill  Publishing  Co.),  the  practical 


Fig.  21. 


FRONT  VIEW  OF  “  PRIMA  ALPHA.” 


It,  should  be  explained  at  the  outset 
that  the  cut  represents  the  band  “b  ” 
“b”  as  located  too  high  on  the  body  of 
the  child. 

”a”  is  body  of  shirt;  *‘b”  “b”  is 
band  worn  around  body  of  child  ;  “  d  ” 
“d”  diaper;  “c”  diaper  shield,  the 
front  end  fastened  on  band  by  two  but¬ 
tons  ;  “f”  “f”  legs  of  drawers  fast¬ 
ened  on  band  on  each  side  where  the 
buttons  are  observed,  and  adjustable 
to  growth  of  child  by  lowering  buttons 
as  desired.  The  points  where  socks  are 
attached  to  legs  of  drawers  by  nursery 
pins  to  prevent  being  kicked  off  by 
activity  of  little  feet,  may  be  seen  just 
above  the  ankles. 

illustrations.  The  lady  had  been 
making  undergarments  for  all  ages 
seems  worthy  of  consideration  here, 


part  of  it  is  presented  here,  with  the 

Fig.  22. 


BACK  VIEW  OF  “PRIMA  ALPHA.” 

In  this,  as  in  the  companion  picture, 
the  cut  represents  the  band“b”  *‘b” 
as  located  too  high  on  the  body  of  the 
child. 

“a”  is  body  of  shirt;  “b”  “b” 
is  band,  worn  around  body  of  child  ; 
“d”  “d”  diaper;  “c”  diaper  shield, 
fastened  on  band  by  two  buttons,  so 
located  as  to  prevent  pressure  on  spine 
or  parts  unprotected  by  bony  structure  ; 
“f”  “f”  legs  of  drawers,  fastened  on 
band  by  button  on  each  side,  a  little 
above  the  letters  “f”  and  adjustable 
to  growth  of  child  by  lowering  buttons 
as  required.  The  points  where  socks 
are  attached  to  legs  of  drawers  are 
observed  a  little  above  the  ankles. 

for  many  years  in  the  business  of 
and  both  sexes,  and  what  she  offers 


HOW  TO  DRESS  THE  BABY. 


133 

“At  birth,  an  infant  in  formal  condition  will  assert  its  right  to  be 
free  by  extending  its  limbs  and  by  cries  that  fill  its  lungs  with  air. 

“But,  alas!  awaiting  its  coming  are  numerous  tortures  called  ‘cloth¬ 
ing/  and  human  hands  ready  to  apply  them  to  the  tender  little  body. 
Where  there  is  no  special  thought,  intelligence,  or  care  in  adjustments 
injuries  are  begotten  which,  in  numberless  cases,  are  lifelong  in  results. 

“  The  inevitable  band  is  closely  pinned  around  the  bowels,  subject¬ 
ing  internal  organs  to  compression,  that  is,  doubtless,  severely  uncom¬ 
fortable  for  the  child.  How  far  this  process  is  accountable  for  so  many 
many  deaths  of  newly  born  babies  we  will  not  here  declare.  But,  it  is 
a  feature  in  dressing  that  receives  far  less  consideration  than  its  serious¬ 
ness  demands. 

“  Next,  the  little  shirt  is  called  forth  from  the  daintily  supplied 
‘basket/ 

“This  needful  garment  of  baby’s  wardrobe  has  undoubtedly  been 
the  subject  of  earnest  endeavor  in  right  directions,  for  it  is  now  ‘the 
fashion  ’  to  have  it  made  of  elastic,  knitted  fabric,  covering  neck  and 
arms  of  infant  with  equal  warmth.  Next  called  for  is  the  diaper, 
which,  as  the  habit  applies  it,  is  the  cause  of  discomfort,  disease  and 
the  ruin  of  many  a  valuable  life.  This  declaration  may  seem  monstrous 
and  indelicately  paraded.  For  a  moment,  consider  the  matter. 

“  It  is  pinned  around  the  loins  of  the  newly  born  babe  in  a  manner 
so  close  that  it  will  not  ‘  bother’  the  nurse  or  mother  by  slipping  off. 
To  keep  it  in  place  it  is  generally  so  folded  and  applied  that  it  prevents 
the  natural  action  of  the  lower  limbs  which  a  baby  would  involuntarily 
indulge  in  if  freed  from  fetterings. 

“ Then  comes  the  long  flannel  ‘petticoat’  or  ‘slip’  made  for  the 
express  purpose  of  hampering  movements  of  the  legs  and  feet  as  well  as 
wrapping  for  warmth.  Over  this  is  worn  the  dress  of  muslin  or  other 
cotton  fabric  anywhere  from  to  1%  yards  in  length. 

“When  thus  fully  dressed,  the  draperies  are  carefully  tucked 
around  the  tiny  limbs  that  would  move  freely  if  permitted  to  do  so — thus 
balancing  the  circulation  of  the  blood  in  the  newly  born  being. 

“Baby  is  placed  in  the  bed,  and  there  again  tucked  about  with  ten¬ 
derness  afid  care. 

“  Now  what  chance  has  the  little  body  for  motion  ?  Or,  if  taken  into 
the  arms  of  an  adult,  think  of  the  drag  upon  the  cartilaginous  frame, 
upon  the  delicate  abdominal  structure  occasioned  by  all  the  weight  of 
‘dry  goods’  fastened,  by  close  pinnings,  around  the  little  body.  The 
long  skirts  flap  and  cling  as  baby  is  lifted  or  perhaps  unwisely  tossed 
by  the  attendant,  and  slipping  out  of  place  for  band,  diaper,  and  skirt  is 
inevitable. 

“Baby  has  no  way  of  expressing  the  suffering  such  weights,  drag¬ 
gings,  displacements,  and  fetterings  occasion,  except  by  cries  that  are 


GENERAL  CARE  OF  THE  CHILD. 


1 3* 

too  often  interpreted  as  calls  for  decoctions,  trottings,  pattingsof  tender 
spine,  etc.,  that  are,  if  possible,  more  mischievous  in  results.  In  general, 
the  beginning  of  infant  life  is  the  duplicate  of  this  recital. 

“  Out  from  such  discomforts  and  deformities  that  often  arise  from 
those  causes  in  infancy,  there  are  many  maimed  ones  whose  existence 
is  a  burden  to  themselves  and  the  world  ;  afflicted  ones  are  not  always 
found  in  homes  where  a  paucity  of  means  and  lack  of  culture  wooed 
and  won  the  sorrow. 

“  How  Can  the  Trend  to  Evil  be  Corrected? — First. — By  com¬ 
mon  sense  displacing  ‘  fashion  *  and  substituting  greatly  shortened  skirts 
for  flannels  and  dress,  so  there  shall  be  entire  freedom  for  the  child’s 
limbs  ‘to  play,’  as  they  surely  will,  if  not  fettered  by  useless  lengths 
and  draperies. 

“  Second. — Let  the  band,  needful  for  clasping  around  the  body  at 
birth,  be  attached  to  the  shirt,  so  that  the  slipping  out  of  proper  place 
may  be  prevented. 

“Third. — To  the  back  of  the  band  attach  a  shield  for  the  diaper. 
The  shield,  placed  under  the  body  of  the  child,  outside  the  diaper  and 
confined  at  the  end  on  the  front  of  band  by  means  of  buttons  or  safety- 
pins.  When  thus  arranged  and  supported  the  shield  bears  the  weight 
of  the  diaper  and  prevents  its  slipping  down  or  off,  thereby  precluding 
the  necessity  for  girding,  too  tightly,  the  loins  of  the  infant. 

“Fourth. — And  specially  important  it  is,  to  cover  the  legs  warmly 
with  drawers  which  will  keep  the  blood  flowing  healthfully  and  not  re¬ 
strict  activity.  Upon  the  little  feet  put  warm  socks,  attach  them  to 
the  legs  of  drawers,  and  when  thus  dressed  and  wisely  managed  baby 
will  enjoy  his  ‘  right  to  be  well  born.’ 

“  Drawers  Upon  a  Newly  Born  Baby !— More  than  one  woman 
has  thus  contemptuously  exclaimed.  But,  we  say,  try  them  for  once. 
Only  little  legs,  of  proper  length  and  size,  for  the  first  dressings  of 
some  warm,  flexible  material,  extending  three  or  four  inches  beyond 
the  little  pink  toes,  keeping  them  warm,  and  serving  as  ‘  socks  ’  or 
coverings  for  the  feet  ;  if  greater  nicety  of  fit  is  desired,  extending 
only  to  the  top  of  foot  of  baby,  and  then  the  warm,  knitted  sock  put  on 
and  fastened  over  bottom  of  drawers  legs.  The  sock  is  confined  by  a 
nursery  pin,  to  the  braid  upon  the  side  of  the  drawers’  ankle,  for  ser¬ 
ving  that  purpose.  The  top  of  drawers’  legs  attached  to  waist-band,  by 
two  buttons  on  the  sides,  over  the  hips. 

“To make  the  full  set  of  appliances  costs  more  of  time  than  for  the 
manufacture  of  the  ordinary  style  of  infants’  underwear.  But,  compare 
the  benefits  to  the  child  with  the  sufferings  occasioned  by  the  usual 
methods,  where  large  sums  are  spent  for  trimmings  for  adornment.”] 


SUN  AND  AIR.  '  "  B,  A.  fZhrtni. 


V 


1 


4 


CHAPTER  XIII. 


Tiie  Nutrition  op  the  Child. 


Mother’s  Milk  the  Natural  Food;  Temporary  Substitute  when  Necessarv; 
Difficulties  of  Sucking;  Frequency;  Amount  of  Milk  obtained;  Use  of  one 
or  both  Breasts;  Indications  of  Discomfort  from  Excess  of  Milk  taken; 
Progress  of  Natural  Nursing;  Insufficiency  of  Supply  of  Milk;  Necessity  of 
Artificial  Supplement;  Eligible  Substitutes;  Use  of  Feeding-bottle;  Tem¬ 
perature  of  Artificial  Food;  Farinaceous  Foods;  Selection;  Quantity  to  be 
given;  Occasional  Inability  to  digest  diluted  Cow’s  Milk;  Alternatives; 
Milk  Humanized;  Sterilized;  Peptonized;  Asses’ Milk;  Goats’ Milk;  Wet- 
nurse;  Addition  of  Farinaceous  Food;  Feeding  by  Spoon;  Addition  of 
Animal  Food;  Objections  to  Nerve-stimulants;  Common  Errors  in  Diet  of 
Infants;  Deficiency  of  Fat;  Excess  of  Farinaceous  Food;  Excess  of  Nitro¬ 
genous  Food ;  Irritability  of  Digestive  Organs  in  Children. 


The  natural  food  for  a  young  infant  is  the  milk  secreted  in 
the  breasts  of  its  mother.  This  secretion  is  generally  present  in  small 
quantity  at  the  time  of  the  birth  of  the  child,  but  is  not  usually  found 
in  abundance  until  a  day  or  two  after  that  event.  During  the  first  one 
or  tw'o  days  of  its  life  the  baby  may  thus  appear  to  have  an  insufficient 
supply  of  milk  ;  in  some  cases,  indeed,  the  supply  may  be  entirely 
absent  for  some  time  after  birth,  not  appearing  until  the  fulness  and 
distention  of  the  breasts  described  in  Chapter  X.  have  developed  on 
the  second  or  third  day  after  parturition.  However  little  milk  there 
may  appear  to  be  in  the  breasts  immediately  after  the  birth’  of  the 
infant,  it  is  always  well  that  it  should  be  induced  to  avail  itself  of  what 
is  present.  The  early  secretion  of  the  breasts  after  confinement  has  a 
peculiar  purgative  action  on  the  child,  which  promotes  the  discharge  of 
the  contents  of  the  bowel  known  as  meconium,  and  prepares  the  alimen¬ 
tary  canal  for  the  due  digestion  of  the  normal  milk  which  succeeds  in 
due  time  the  first  secretion.  The  sucking  action  of  the  infant  also 
acts  as  a  stimulus  to  the  lacteal  glands  of  the  mother,  while,  at  the 
same  time,  her  nipples  are  drawn  out  and  made  more  easily  available 
for  the  future  demands  of  the  child.  Unless  an  infant  is  very  wakeful 
and  fretful  during  the  first  one  or  two  days  of  life,  it  is  not  desirable, 
and  certainly  it  is  not  necessary,  to  give  it  any  food  beyond  what  it  is 
able  to  extract  from  its  mother’s  breasts.  There  is  not  the  slightest 

risk  of  the  baby  suffering  in  any  way  from  starvation,  even  if  it  has  to 

135 


THE  NUTRITION  OF  THE  CHILD. 


136 

wait  two  or  tliree  days  for  an  ample  secretion  of  milk ;  and  it  will 
digest  and  utilize  its  mother’s  milk  to  greater  advantage  when  the  flow 
does  come,  if  its  stomach  has  not  been  irritated  in  any  way  by  the 
administration  of  artificial  food  in  the  interval  of  waiting. 

Temporary  Substitute. — When,  however,  fretfulness,  wakeful¬ 
ness,  and  apparent  hunger,  indicated  by  ravenous  suction  at  the 
breasts,  indicate  the  propriety  of  temporarily  satisfying  the  wants  of  the 
child,  the  most  appropriate  food  is  cow’s  milk  diluted  with  water  to 
the  extent  of  double  the  quantity  of  the  milk,  and  slightly  sweetened 
with  white  sugar,  or  sugar  of  milk.  This  should  be  administered 
either  by  means  of  a  spoon  or  from  a  bottle,  and  should  be  given  in 
quantities  of  not  more  than  two  tablespoonfuls  (one  fluid  ounce)  at  a 
time,  and  not  more  frequently  than  every  two  hours.  As  soon  as  there 
are  indications  that  the  breasts  are  secreting  satisfactorily,  the  artificial 
feeding  should  cease  at  once.  These  indications  will  be  found  in  the 
fulness  and  hardness  of  the  breasts,  in  the  discharge  of  milk  from  the 
nipples,  and  in  the  facility  with  which  slight  pressure  on  the  breasts 
will  cause  a  flow  from  the  nipple. 

Difficulties  of  Sucking — Considerable  difficulty  is  sometimes  ex¬ 
perienced  in  inducing  the  baby  to  suck  the  breasts  properly,  more 
especially  when  the  milk  is  rather  difficult  to  extract,  or  when  it  has 
been  fed  artificially  for  two  or  three  days  from  a  bottle,  from  which  it 
is  considerably  easier  to  extract  the  milk  than  from  its  mother’s  breast. 
Breasts  vary  considerably  both  in  the  form  of  the  nipple  and  in  the 
facility  with  which  the  milk  flows  from  the  ducts,  even  when  the  quan¬ 
tity  may  be  plentiful.  The  baby  must  in  cases  of  difficulty  be  induced 
to  suck  properly  and  strongly,  in  the  first  place  by  the  stimulus  of 
hunger,  and  in  the  second  place,  when  necessitated  by  the  want  of 
projection  of  the  nipple,  by  the  assistance  of  artificial  nipples,  and  by 
the  pressure  of  the  hand  of  the  mother  or  nurse  upon  the  breast.  In 
Chapter  X.  a  description  has  been  given  of  the  kind  of  artificial  nipple 
which  should  be  used  for  this  purpose,  together  with  directions  for  its 
employment.  In  all  cases  where  undue  difficulty  presents  itself  in 
sucking,  and  where  this  difficulty  is  not  apparently  owing  to  any  defi¬ 
ciency  in  the  supply  of  milk,  or  any  want  of  projection  or  malforma¬ 
tion  of  the  nipple,  a  careful  examination  should  be  made  of  the  mouth 
and  tongue  and  nose  of  the  infant.  Children  are  occasionally  born  with 
a  perforation  in  the  roof  of  the  mouth  communicating  with  the  nose, 
and  when  this  is  present  suction  becomes  impossible  without  some  arti¬ 
ficial  aid.  It  is  very  seldom  indeed  that  the  abnormal  connection  of 
the  under  side  of  the  tongue  with  the  floor  of  the  mouth,  known  as 
“tongue-tying,”  exists  to  such  an  extent  as  to  limit  very  materially  the 
capacity  for  suction  ;  but  when  other  difficulties  are  present,  it  may 
add  to  them,  and  accordingly  call  for  remedy  bjr  a  slight  and  unim- 


frequency  of  suckling. 


137 


portant  incision.  Catarrh  of  the  nose  interferes  very  seriously  with  the 
power  of  sucking  strongly,  and  when  present  may  call  for  a  consider¬ 
able  amount  of  attention.  It  is  only  after  exhausting  all  possible 
sources  of  difficulty  that  one  is  entitled  to  assume  that  the  infant  has  a 
dislike  to  the  milk  of  the  mother,  and  must  be  humored  by  being  fed 
in  some  artificial  manner. 

Frequency  of  Suckling. — A  recently  born  infant  usually  requires 
nursing  at  intervals  of  about  two  hours  during  the  day,  and  of  about 
three  hours  during  the  night.  This  will  give  an  average  of  nine  or  ten 
administrations  of  food  in  the  twenty-four  hours.  At  each  of  those 
times  it  will  probably  receive  from  one  to  two  fluid  ounces  of  milk, 
which  will  amount  to  between  half  a  pint  and  a  pint  in  a  whole  day 
and  night.  Experiment  and  observation  have  shown  that  the  average 
capacity  of  an  infant’s  stomach  at  birth  is  about  one  fluid  ounce,  but, 
being  elastic,  the  stomach  is  capable  of  some  distention  beyond  this ; 
and  when  the  supply  of  milk  is  abundant,  strong  babies  almost  invari¬ 
ably  exhaust  from  the  breast  somewhat  more  than  they  can  comforta¬ 
bly  digest  and  absorb.  The  secretion  of  milk  by  the  breast  of  the 
mother  varies  somewhat  with  the  frequency  with  which  it  is  exhausted  ; 
on  an  average,  it  usually  amounts  to  quite  a  pint  in  the  twenty-four 
hours,  and  may  attain  to  double  that  amount.  When  excessive  calls 
are  made  on  the  breasts,  however,  either  by  the  voracity  of  one  strong 
infant,  or  by  the  attempt  to  suckle  two  together,  the  milk  is  apt  to 
degenerate  considerably  in  quality. 

When  the  supply  of  milk  is  good,  it  is  usually  sufficient  to  give 
only  one  breast  to  the  young  infant  at  each  time  of  nursing ;  and  by 
alternating  the  breasts  at  successive  meals  a  longer  period  of  rest 
is  given  to  the  nipple,  and  a  somewhat  less  tax  is  imposed  on  the 
health  of  the  mother.  On  this  point  also  reference  may  be  made  to 
Chapter  X. 

Difficulties  of  Digestion. — When  the  baby  has  taken  more  milk 
than  it  can  comfortably  accommodate,  it  shows  immediately  after  the 
nursing  is  completed  signs  of  uneasiness  and  fretfulness.  These  may 
be  accompanied  by  slight  eructations  of  wind,  and  are  generally  fol¬ 
lowed  by  vomiting  of  the  excess  of  milk,  after  which  rest  and  comfort 
ensue.  In  young  infants  the  act  of  vomiting  is  not  in  any  degree  the 
painful  process  which  it  invariably  is  when  occurring  in  adults. 
Rather  is  it  a  gentle  emptying  of  superfluous  contents  without  any  un¬ 
comfortable  exertion,  and  without  any  subsequent  depression.  The 
sensation  of  nausea  appears  not  to  affect  babies  ;  before  the  stomach  is 
relieved  they  seem  to  have  no  discomfort  beyond  the  sense  of  distention, 
aud  after  the  relief  from  partial  evacuation  of  the  contents,  they  are 
usually  perfectly  happy,  and  settle  down  to  the  digestion  of  what 
remains  with  a  sense  of  placid  well-being. 


TTTF  NUTRITION  OF  THE  CHILD. 


138 

When  sickness  in  babies  is  due  only  to  an  overcharged  stomach, 
the  milk  vomited  has  a  perfectly  fresh  odor,  and  is  little  if  at  all 
curdled.  When  the  cause  of  the  sickness,  on  the  other  hand,  is  irrita¬ 
bility  of  the  stomach,  or  some  change  in  the  quality  of  the  milk,  mak¬ 
ing  it  more  difficult  of  digestion,  the  vomiting  usually  occurs  some 
time  after  the  ingestion  of  the  food,  and  the  vomited  matter  has  a  sour, 
unpleasant  smell,  and  is  usually  markedly  curdled.  When  this  is 
noticed,  attention  must  be  directed  to  the  general  health  of  the  mother, 
and  to  the  possibility  of  her  having  taken  any  food  or  medicine  likely 
to  prove  injurious  to  the  quality  of  the  milk.  In  the  vast  majority  of 
cases  of  irritability  of  digestion  in  young  infants  nursed  exclusively  by 
their  mothers,  some  local  or  general  cause  affecting  the  condition  of 
the  milk  will  be  discovered.  In  some  cases  it  may  be  traced  to  some 
unwonted  food  partaken  of  by  the  mother  ;  in  others  to  some  local 
irritable  condition  of  the  breast ;  and  in  others,  again,  to  general  dis¬ 
order  of  the  mother’s  health,  such  as  results  from  a  feverish  attack,  or 
from  the  recommencement  of  the  menstrual  flow.  Whatever  the  cause 
may  be  found  to  be,  treatment  must  be  directed  to  remove  it.  It  is 
useless  and  absurd  to  direct  treatment  to  the  digestion  of  the  baby  so 
long  as  the  cause  persists  which  has  initiated  the  disorder,  and  contin¬ 
ues  to  aggravate  it, 

Another  important  indication  of  the  suitability  of  the  milk  to  the 
infant  is  found  in  the  character  of  the  motions  passed  from  the  bowel. 
When  the  digestion  is  healthy,  even  though  the  stomach  be  occasion¬ 
ally  overcharged  with  food,  the  motions  will  be  observed  uniform  in 
character  and  consistency,  and  of  a  healthy  yellow  color.  When  the 
digestion  is  impaired,  and  the  digestive  canal  irritated,  the. motions  will 
usually  become  of  a  pale  color,  undigested  curdled  masses  of  milk  will 
be  found  mixed  with  the  usual  fecal  matter,  and  often  a  considerable 
quantity  of  greenish  gelatinous  matter,  known  as  mucus,  will  be  mixed 
with  the  motion.  If  the  irritation  be  considerable,  the  motion  may  not 
(infrequently  be  seen  to  consist  almost  entirely  of  this  greenish  mucus, 
with  which  occasionally  will  be  mixed  fragments  of  curdled  milk. 
When  the  motions  become  thus  unhealthy  and  abnormal  in  character, 
they  form  conclusive  evidence  of  some  disorder  of  digestion,  and  atten¬ 
tion  should  be  at  once  directed  to  discover  and  eliminate  the  cause  of 
the  derangement. 

Gradual  Decrease  in  Frequency.— When  the  baby  attains  the 
age  of  two  to  three  months,  the  intervals  between  the  periods  of  nur¬ 
sing  should  be  somewhat  lengthened,  more  especially  at  night.  At  this 
age  an  infant  should  not  generally  be  given  the  breast  oftener  than 
every  two  and  a  half  hours  during  the  day,  and  may  even  wait  for 
three  hours,  while,  during  the  night,  an  interval  of  between  three  and 
four  hours  between  the  periods  of  nursing  may  be  attained.  The 


LACK  OF  BREAST  MILK. 


139 


capacity  of  the  stomach  has  now  considerably  increased,  and  the  infant 
is  able  to  retain  from  twice  to  three  times  as  much  milk  as  it  could  do 
immediately  after  birth.  In  the  case  of  children  of  normal  strength,  it 
is  always  well  to  make  the  intervals  between  the  periods  of  nursing  as 
long  as  possible.  The  infant  in  this  way  manages  to  complete  thor¬ 
oughly  the  digestion  of  one  meal  before  commencing  another,  and  the 
risk  of  irritation  is  very  much  diminished,  while  the  mother  escapes 
harassing  frequency  of  nursing,  and  is  not  exhausted  so  much  by  her 
maternal  duties.  More  especially  should  the  night  intervals  be  length¬ 
ened  to  the  utmost  extent,  in  order  to  allow  the  mother  as  much  undis¬ 
turbed  sleep  as  possible. 

At  the  age  of  jive  to  six  months  many  babies  will  allow  of  an  interval 
of  fully  three  hours  during  the  day,  while  at  night  they  will  be  satis¬ 
fied  by  being  nursed  when  the  mother  retires  to  rest,  and  once  again 
between  five  and  six  in  the  morning.  At  this  stage  a  baby  who  is 
being  exclusively  nursed  by  its  mother  will  probably  remain  until 
weaned. 

Insufficiency  of  Supply  of  iTilk. — Not  unfrequently  it  happens 
that  while  the  breasts  of  the  mother  secrete  a  certain  quantity  of  milk 
after  confinement,  this  is  not  sufficient  to  satisfy  the  wants  of  the  infant. 
It  may  be  observed  that  the  baby  continues  to  suck  after  all  the  milk 
has  been  exhausted,  or,  finding  the  supply  at  an  end,  it  may  leave  off 
hungry  and  dissatisfied,  and  desirous  of  more  food  after  a  very  short 
interval.  It  will  usually  be  remarked  in  such  cases  that  the  baby  does 
not  progress  with  normal  rapidity,  and  if  the  breasts  of  the  mother  be 
examined  immediately  before  nursing,  they  will  be  found  wanting  in 
the  fulness  and  tension  of  breasts  which  are  duly  charged  with  milk. 
When  this  condition  occurs,  it  is  necessary  at  once  to  supplement  the 
mother’s  milk  by  some  artificial  food.  Suckling  by  the  mother  should 
not  be  stopped  entirely  if  the  milk  agrees  with  the  child,  and  is  defi 
cient  only  in  quantity,  but  a  longer  interval  between  the  acts  of  nur¬ 
sing  must  be  allowed  to  admit  of  the  breasts  becoming  more  full,  and 
in  the  intervals  between  the  periods  of  nursing  some  substitute  for  the 
mother’s  milk  must  be  provided. 

Fresh  Cow’s  Hilk,  diluted  with  two  or  three  times  its  bulk  of 
water,  and  slightly  sweetened,  will  be  found,  as  a  rule,  the  most  satis¬ 
factory  substitute  for  the  mother’s  milk,  when  arrangements  can  be 
made  to  obtain  a  regular  supply  two  or  three  times  daily  of  fresh 
milk  from  the  same  cow,  and  reliance  can  be  placed  on  its  purity.  It 
is  found  generally  that  when  fresh  cow’s  milk  is  employed  as  the  food 
of  young  infants,  it  is  more  easily  digested  if  the  milk  be  always  ob¬ 
tained  from  the  same  cow,  the  stomachs  of  infants  being  sensitive 
to  minute  alterations  in  the  character  of  the  milk  winch  cannot  be 
discovered  by  any  process  of  examination  or  analysis.  An  infant’s 


140 


THE  NUTRITION  OP  THE  CHILD. 


stomach  will  also  detect  slight  sourness  in  the  milk  long  before  it 
becomes  apparent  to  the  taste  or  other  senses  of  the  adult,  and  will 
resent  the  sourness  by  ejecting  the  milk,  so  that  it  is  most  important, 
more  especially  in  summer,  that  the  cow’s  milk  should  be  obtained 
fresh  two  or  three  times  a  day.  Milk,  if  boiled  when  fresh,  does  not 
turn  sour  so  quickly  as  unboiled  milk,  and  the  freshness  can  be  main' 
tained  also  for  some  time  by  the  addition  of  a  small  quantity  of  biear- 
bonate  of  soda  to  the  new  milk,  about  ten  grains  of  bicarbonate  of  soda 
(as  much  as  can  be  heaped  on  a  dime)  being  used  for  a  pint  of  milk. 

These  methods  of  keeping  milk  fresh  are  not,  however,  perfectly 
satisfactory,  as  the  boiling  somewhat  alters  the  character  of  the  milk 
and  makes  it  a  little  more  difficult  of  digestion,  while  the  quantity  of 
bicarbonate  of  soda  used,  if  its  employment  is  continued  for  a  time, 
may  weaken  to  some  extent  the  digestion  of  the  infant. 

Condensed  Cow’s  Milk. — When  difficulty  is  experienced  in  ob¬ 
taining  fresh  milk  for  the  diet  of  the  child,  it  is  better  to  resort  to  the 
use  of  condensed  milk,  and  if  one  particular  brand  be  adhered  to,  the 
milk  is  usually  so  uniform  in  character  that  the  infant’s  stomach  dis¬ 
covers  no  difference  in  quality  in  the  successive  tins  opened.  Con¬ 
densed  milk  is  simply  cow’s  milk  which  has  been  for  some  time  exposed 
to  a  temperature  equal  to  that  of  boiling  water,  for  the  purpose  in  the 
first  place  of  destroying  any  germs  which  may  give  rise  to  decomposi¬ 
tion,  and  in  the  second  place  of  concentrating  its  strength  by  evapora¬ 
ting  the  water  in  it  ;  and  which  has  then  been  enclosed  in  air-tight 
tins.  In  some  brands  a  certain  amount  of  sugar  is  added  to  facilitate 
the  preservation  ;  in  others  this  is  omitted,  and  the  milk  is  sold  under 
the  name  of  “unsweetened”  condensed  milk.  Generally  speaking,  the 
unsweetened  is  now  preferred  to  that  with  sugar  added  ;  but  both 
seem  to  agree  equally  well  with  many  babies  ;  and  perhaps  the  only 
advantage  which  the  unsweetened  has  over  the  sweetened  is,  that  it 
keeps  fresh  after  the  air-tight  tin  has  been  opened  for  a  somewhat 
longer  period.  The  difficulty  of  keeping  the  milk  fresh  after  a  tin  has 
been  opened  is  the  main  drawback  to  the  use  of  condensed  mirk. 
Otherwise  it  is  a  very  eligible  food  for  infants,  as  decomposition  is  ob¬ 
viated  by  the  exposure  to  heat,  while  its  digestibility  lias  not  been 
impaired  by  boiling.  It  would  be  of  much  advantage  if  it  were  put  up 
in  much  smaller  tins  than  it  is  usually  stored  in,  so  that  a  fresh  tin 
might  be  opened  at  least  once  every  day.  In  diluting  fresh  cow’s  milk 
or  condensed  milk,  water  which  has  been  boiled  should  always  be  em¬ 
ployed,  and  the  addition  of  a  little  sugar  of  milk  may  be  necessary  to 
induce  the  baby  to  take  it  readily,  as  cow’s  milk  diluted  to  the  extent 
mentioned  above  is  not  nearly  so  sweet  as  the  milk  of  the  mother. 

Necessity  for  Dilution. — Cow’s  milk,  whether  tresh  or  con¬ 
densed,  is  not  so  easily  digested  as  mother’s  milk.  When  the 


FIXING  COW’S  MILK  FOR  INFANTS. 


141 

digestion  of  mother’s  milk  commences  in  the  stomach,  it  is  altered  into 
small  soft  particles  of  curd,  which  are  easily  permeated  by  the  gastric 
juice,  and  reduced '  again  to  a  uniform  solution  capable  of  being 
absorbed  by  the  walls  of  the  stomach  and  intestines.  Cow’s  milk,  on 
the  other  hand,  curdles  in  the  stomach  into  somewhat  hard  and  large 
masses,  which  resist  the  action  of  the  gastric  juice,  and  are  apt  occa¬ 
sionally  to  irritate  the  walls  of  the  stomach  and  produce  pain.  The 
object  of  the  dilution  which  has  been  recommended  is  mainly  to  pre¬ 
vent  this  curdling,  or  at  least  to  reduce  the  size  of  the  masses  of  curd, 
and  diminish  their  hardness  so  far  as  to  allow  of  the  gastric  juice  exer¬ 
cising  satisfactorily  upon  them  its  digestive  influence.  To  chemical 
analysis  the  milk  of  cows  .is  not  very  much  richer  than  human  milk,  and 
very  little  dilution  would  be  required  to  render  it  acceptable  to  babies 
if  it  were  not  for  its  tendency  to  coagulate  in  hard  masses.  The  pre¬ 
vention  of  this  is  even  more  effectively  carried  out  if  thin  barley-water 
is  used  for  dilution  in  place  of  simple  boiled  water.  Barley-water  em¬ 
ployed  for  this  purpose  should  be  made  from  ordinary  pearl  barley, 
about  a  full  teaspoonful  of  which  should  be  washed,  and  then  boiled 
for  twenty  minutes  in  a  pint  of  water.  When  this  has  been  strained 
and  allowed  to  cool  it  is  ready  for  mixing  with  the  milk.  Barley-water 
does  not  keep  long  without  deterioration  ;  a  fresh  supply  should  there¬ 
fore  be  made  daily. 

Cow’s  milk  is  usually  somewhat  more  acid  than  human  milk,  and 
when  indications  are  given,  by  the  infant  vomiting  milk  with  a  very 
acid  smell  soon  after  drinking  the  diluted  cow’s  milk,  that  the  acidity  is 
creating  irritation,  it  should  be  neutralized  by  the  addition  of  some 
lime-water  or  a  little  bicarbonate  of  soda.  If  lime-water  is  used, 
it  should  replace  one-half  of  the  water  or  barley-water  employed  to 
mix  with  the  milk ;  if  bicarbonate  of  soda  is  preferred,  about  as 
much  as  will  lie  on  a  threepenny  bit  [or  half  dime]  may  be  added  to 
each  meal.  Lime-water  should  usually  be  preferred  when  there  is  a 
tendency  to  relaxation  of  the  bowels  ;  bicarbonate  of  soda  when  the 
baby  inclines  to  constipation. 

Condensed  milk  does  not  usually  curdle  in  such  hard  or  large 
masses  as  "fresh  cow’s  milk,  and  accordingly  does  not  require  to  be 
diluted  to  a  proportionate  extent ;  but  it  must  be  remembered  it  requires 
the  addition  of  a  considerable  amount  of  water  to  replace  what  has  been 
evaporated  in  the  preparation,  so  as  to  restore  it  to  the  condition  of  un¬ 
diluted  fresh  milk.  This  replacing  dilution  is  generally  stated  on  the 
outside  of  the  tins  in  which  the  milk  is  stored  ;  it  differs  a  good  deal 
in  different  brands  of  condensed  milk.  As  a  rule,  condensed  milk,  like 
fresh  cow’s  milk,  will  be  found  to  digest  better  when  diluted  with  barley- 
water  than  with  plain  boiled  water  ;  in  using  it  the  addition  of  an  alkali, 
either  lime-water  or  bicarbonate  of  soda,  may  be  necessary. 


142 


THE  NUTRITION  OF  THE  CHILD. 


Feeding  Betties. — When  artificial  food  is  given  to  young  infants, 
it  ought  to  be  administered  through  a  proper  feeding-bottle,  from  which 
the  baby  can  suck  the  milk,  just  as  it  does  from  its  mother’s  breast. 
Bottles  are  made  of  various  designs  by  different  makers,  and  their 
merits  are  urged  on  various  grounds.  By  far  the  most  important  qual¬ 
ity  of  an  infant’s  feeding-bottle  is,  that  it  should  be  of  such  shape  and 
construction  as  to  admit  of  thorough  cleanliness.  All  other  cliarac 
teristics  of  bottles  are  simply  questions  of  convenience  ;  cleanliness  is  a 
matter  of  vital  importance. 

Generally  speaking,  the  simpler  the  construction  of  a  bottle,  the 
more  easy  it  is  to  keep  it  thoroughly  clean.  The  ideal  bottle  is  one  made 
entirely  of  glass,  except  the  nipple,  which  should  be  of  india-rubber, 
easily  detached  from  the  bottle,  and  easily  replaced.  Tllbre  should  be 
no  corners  in  it,  and  a  simple  opening  at  one  part  to  allow  the  milk  to 
be  poured  in,  closed  with  a  glass  stopper,  with  a  groove  in  it,  which 
should  be  able  to  be  turned  so  as  to  admit  a  little  air  as  the  baby  ex¬ 
hausts  the  milk.  India-rubber  tubing,  connecting  the  bottle  with  the 
nipple,  should  not  be  made  use  of.  It  is  exceedingly  difficult  to  keep  per¬ 
fectly  clean,  and  as  the  inside  of  it  cannot  be  thoroughly  inspected,  it 
is  impossible  to  be  satisfied  of  its  absolute  freedom  from  impure  matter. 
It  also  affords  undesirable  opportunities  for  the  mother  or  nurse  neglect¬ 
ing  the  infant  during  the  process  of  feeding,  as  with  the  tubing  the 
bottle  may  be  placed  in  any  position  while  the  baby  exhausts  it  through 
the  tube.  In  such  an  important  matter  as  feeding  a  baby,  individual 
attention  should  be  given  by  the  nurse  or  mother  to  the  process,  and 
the  bottle  should  be  held  in  the  hand  of  the  administrator  until  the  in¬ 
fant  has  satisfied  its  wants.  The  bottle  should  then  be  washed  out  as 
soon  as  possible  with  hot  water,  the  india-rubber  nipple  having  been 
first  removed,  and  should  be  left  lying  in  clean  water  until  again  re¬ 
quired.  When  necessary,  a  little  soda  may  be  added  to  the  hot  water 
used  for  washing  the  bottle,  if  there  is  any  difficulty  in  making  it  thor 
oughly  clean.  The  india-rubber  nipple  should  be  washed  carefully  with 
cold  water  in  which  a  little  boracic  acid  has  been  dissolved  ;  about  a  tea¬ 
spoonful  of  boracic  acid  to  half  a  pint  of  water  makes  a  convenient  solu¬ 
tion  for  this  purpose.  After  being  washed  carefully,  the  nipple  may 
be  replaced  on  the  bottle.  In  order  to  obviate  any  possibility  of  the 
baby  sucking  the  nipple  off  the  bottle  and  swallowing  it,  it  is  usual  to 
surround  it  with  a  flat  ivory  collar,  which  rests  against  the  outside  of 
the  lips  when  the  baby  is  being  fed,  and  prevents  the  nipple  from  being 
drawn  too  far  into  the  mouth. 

Temperature  of  Artificial  Food. — Artificial  food  given  to  young 
infants  should  always  be  warmed  to  a  temperature  approaching  that 
of  the  body.  It  is  best  to  ascertain  this  by  the  use  of  a  clinical  ther¬ 
mometer,  such  as  is  described  in  Chapter  NVI.,  the  temperature  of  the 


FARINACEOUS  FOODS. 


143 


food  being  regulated  by  its  use  so  as  not  to  exceed  98°  F.,  and  not  to  fall 
below  90°  F.  Many  nurses  judge  of  the  temperature  of  the  food  by 
tasting  it,  and  a  careful  nurse  is  not  likely  to  make  any  mistake  if  she 
takes  this  precaution  before  administering  the  food,  but  the  application 
of  the  thermometer  is  so  simple  and  occupies  so  little  time  that  it  is 
always  best  to  make  use  of  it  in  preparing  the  meals  of  very  young  in¬ 
fants.  Bottles  have  recently  been  introduced  fitted  with  thermometers 
for  this  purpose  ;  they  are  convenient  in  use,  but  liable  to  breakage. 

During  the  first  six  months  of  life  it  is  best  not  to  use  any  food 
except  the  preparations  of  milk  already  described,  or  the  others  to  be 
mentioned  later,  in  supplement  of  the  milk  of  the  mother.  After  this 
age,  if  the  baby  is  making  satisfactory  progress,  a  little  farinaceous 
food  of  some  kind  may  be  given. 

Farinaceous  Foods  may  be  classified  under  three  heads :  those 
which  have  not  been  subjected  to  any  special  preparation,  those  which 
have  been  already  partially  cooked,  and  those  that  have  been  malted, 
or  partially  predigested  in  some  other  manner.  Of  the  first  the  most 
commonly  used  are  fine  oatmeal,  barley,  hominy,  corn-flour  and  arrow- 
root.  Of  the  prepared  foods  the  number  is  now  so  great  that  it  is 
impossible  to  attempt  an  exhaustive  list. 

[Dr.  Westland  names  a  few  of  the  favorite  proprietary  foods  used 
in  England,  but  most  of  them  are  not  to  be  had  in  all  parts  of  the 
United  States,  and  as  this  edition  is  intended  for  wridc  circulation,  it 
may  be  as  well  not  to  make  mention  of  any.  It  is  almost  superfluous 
to  remark  that  we  have  enough  of  our  own  in  the  great  variety  of 
specially  prepared  “  infants’  foods,”  each  of  which  is  loudly  proclaimed 
as  “  the  best”  by  its  manufacturer.  Every  maker  is  able  to  exhibit  in 
his  circulars  and  advertisements  a  number  of  testimonials  from  mothers 
and  physicians  which  seem  to  prove  the  acceptability  and  utility  of 
these  products  ;  and  we  incline  to  give  them  all  credit  for  an  honest 
eifort  to  provide  a  generally  reliable  form  of  artificial  or  substitute 
food  for  infants.  Many  physicians  may  have  found  reason  for  pre- 
fering  one  to  another,  and  when  any  food  is  prescribed  the  mother  may 
do  well  to  follow  master,  and  place  the  responsibility  for  results  on  the 
doctor  wdio  is  advising  her.  No  doubt  some  of  these  prepared  foods 
are  well  adapted  to  some  infants  and  not  to  others.  There  are  babies 
that  find  their  own  mother’s  milk  incompatible,  and  some  artificial 
food  may  do  better.  It  is  not  surprising  that  with  infants  as  vdtli 
adults  a  variety  of  foods  is  necessary  to  suit  all  wants  ;  but,  if  we  read 
aright  the  signs  of  the  times,  and  the  drift  of  professional  views  on 
infant  feeding,  there  is  an  increasing  disposition  to  set  aside  the  manu¬ 
factured  substitutes,  and  to  find  wdiat  every  suckling  babe  requires  in 
some  combination  of  what  is  now  prescribed  as  “modified  milk,” 
which  is  in  fact  a  sterilized  milk  made  to  order. 


i44 


THE  NUTRITION  OF  THE  CHILD. 


In  the  larger  cities  there  are  laboratories  where  cow's  milk  is 
treated  in  a  way  to  free  it  from  all  uncleanness  and  germs,  separate  its 
elements,  and  recombine  them  in  definite  proportions,  so  that  a  pre¬ 
scription  can  be  written  for  an  infant’s  daily  food  that  may  fit  it  better 
than  the  mother’s  breast  milk,  and  which  can  be  varied  from  week  to 
week  as  the  child  grows.  Thus  each  infant’s  day’s  rations  is  delivered 
daily  in  six  or  eight  portions,  each  feeding  in  one  tube,  and  all  in  one 
neat  box  or  basket  which  should  be  kept  in  a  refrigerator.  Each  tube 
is,  just  before  feeding,  warmed  to  proper  temperature,  gauged  by  a 
thermometer,  and  as  the  size  of  the  tube  is  fixed  according  to  the 
infant’s  age,  it  is  presumable  that  the  child  gets  just  the  right  kind  of 
food,  in  right  amount,  at  right  temperature,  and  at  proper  intervals. 
This  is  the  latest  scientific  fashion  in  the  attempt  to  arrange  for  an 
accurate,  safe,  and  satisfactory  substitute  for  nature’s  font,  where  for 
any  reason  that  is  not  available  or  satisfactory.  Apparatus  has  also 
been  devised  by  which  this  plan  of  modifying  milk,  or  making  over 
cow’s  milk  into  an  exact  substitute  for  mother’s  milk,  can  be  managed 
“at  home  ”  by  mothers  who  have  no  access  to  the  special  laboratories 
already  mentioned.  It  is  not  too  elaborate  or  expensive  for  the  average 
mother,  and  not  beyond  the  intelligent  understanding  of  those  who 
would  read  thus  far  in  this  book  ;  but,  outside  of  cities,  and  especiall}r 
where  the  milk-supply  is  near  at  hand,  good  at  the  source  and  not 
subject  to  the  changes  of  transportation  and  of  time,  the  simple 
addition  of  pure  water  and  cream  in  right  proportions  (and  sometimes 
of  barley-water  or  lime-water)  will  suffice  in  place  of  a  more  painstaking 
modification.  As  cow’s  milk  may  be  acid,  and  as  infants  require  an 
alkaline  food  solution,  it  is  customary  to  use  lime-water  to  correct  this 
fault  of  cow’s  milk,  but  lime  is  so  little  soluble  in  wrater  that  enough 
cannot  be  dissolved  to  make  an  over-dose.  One  spoonful  of  lime-water 
to  sixteen  of  milk  will  suffice.] 

The  Bringing=up  of  an  Infant  “  by  Hand.” — Speaking  general¬ 
ly  it  is  only  during  the  first  six  months  of  an  infant’s  life  that  much 
difficulty  presents  itself  in  the  selection  and  management  of  food,  and 
having  brought  the  baby,  entirely  or  partially  nursed  by  its  mother,  to 
this  point,  a  convenient  opportunity  presents  itself  of  reverting  to  the 
commencement  of  life,  and  considering  the  diet  appropriate  to  infants 
who,  for  various  reasons,  are  unable  to  enjoy  the  comfort  and  advan¬ 
tage  of  maternal  nutrition. 

When  it  has  been  decided  that  a  baby  is  to  be  brought  up  on  arti¬ 
ficial  food,  or  “by  hand,”  as  it  is  sometimes  technically  called,  it  is 
usual  to  commence  with  the  administration  of  diluted  cow’s  milk,  wdiich 
may  be  either  fresh  or  condensed.  Whichever  of  the  two  is  selected — 
and  the  selection  must  be  made  on  grounds  already  laid  down  at  p. 
139— should  be  diluted  with  boiled  water  or  with  barley-water,  in  the 


BOTTLE-FEEDING. 


145 


proportion  already  described  as  suitable  for  new-born  infants  as  an 
addition  to  the  mother’s  milk,  and,  slightly  sweetened  with  sugar  of 
milk,  should  be  administered  through  a  bottle  about  every  two  hours, 
in  quantities  suited  to  the  capacity  of  the  stomach.  Immediately  after 
birth  from  one  to  two  fluid  ounces — a  fluid  ounce  containing  about  two 
tablespoonfuls — is  a  proper  quantity  ;  when  the  baby  is  a  month  old 
about  three  ounces  may  be  given,  and  this  may  be  increased  to  about 
four  ounces  when  the  age  of  two  months  has  been  attained.  At  three 
months  of  age  about  five  ounces  of  food  will  usually  be  taken  at  a  meal 
with  comfort,  and  before  the  age  of  six  months  is  reached  a  baby  may 
not  be  satisfied  with  less  than  six  to  eight  ounces  at  a  time. 

Usually  a  baby  fed  on  cow’s  milk  from  the  bottle  will  require  food 
rather  more  frequently  than- one  nursed  by  its  mother,  but  it  is  always 
well  to  lengthen  the  intervals  as  much  as  the  child  will  permit.  The 
amount  of  dilution  necessarv  to  aid  the  digestion  of  the  cow’s  milk 
diminishes  the  nutritive  value  in  proportion  to  the  quantity.  A  baby 
nursed  ten  times  in  the  twenty-four  hours,  and  obtaining  an  ounce  and 
a  half  of  milk  from  the  breast  at  each  period  of  nursing,  would  receive 
in  the  course  of  the  day  and  night  fifteen  ounces  of  pure  milk.  On  the 
other  hand,  a  baby  fed  by  hand,  and  receiving  two  ounces  of  a  dilution 
of  one-third  of  milk  to  two-thirds  of  water  every  two  hours,  would 
only  obtain  eight  ounces  of  pure  cow’s  milk  in  the  twenty-four  hours, 
the  other  sixteen  ounces  being  water  or  barley-water,  of  comparatively 
little  nutritious  value.  It  is  true  that  undiluted  cow’s  milk  is  some¬ 
what  richer  than  mother’s  milk,  but  not  so  much  so  as  to  make  eight 
ounces  of  the  one  equivalent  to  fifteen  ounces  of  the  other.  Babies, 
however,  do  progress  quite  satisfactorily  upon  an  allowance  of  from 
eight  to  ten  ounces  of  pure  cow’s  milk  daily,  so  that  it  is  probable  that 
the  estimate  of  the  mother’s  milk,  as  amounting  to  fifteen  ounces  daily 
immediately  after  confinement,  may  be  somewhat  overstated. 

When  the  baby  has  reached  the  age  of  six  weeks ,  the  amount  of  dilu¬ 
tion  of  the  milk  may  be  somewhat  lessened  ;  and  at  three  months  most 
infants  will  take  easily  cow’s  milk  diluted  with  an  equal  quantity  of 
water  or  barley-water.  At  this  age  a  healthy  baby  will  allow  of  inter¬ 
vals  of  at  least  three  hours  between  its  meals,  and  calculating  that  it 
has  seven  meals  in  the  twenty-four  hours,  and  takes  at  each  meal  five 
ounces  of  diluted  milk,  it  will  receive  not  much  less  than  a  pint  of  pure 
milk  during  the  day  and  night.  The  remarks  about  dilution  apply 
equally  to  fresh  milk  and  condensed  milk,  it  being  remembered  always 
that  the  condensed  milk  requires  an  initial  dilution  to  restore  it  to  the 
condition  of  fresh  milk. 

After  the  age  of  three  months  the  capacity  of  the  stomach  in¬ 
creases  more  slowly,  so  that  the  quantity  of  food  given  at  a  meal  can 
be  augmented  only  very  gradually  ;  but  the  digestive  power  usually 


THE  NUTRITION  OF  THE  CHILD. 


146 

increases  rapidly,  and  it  is  possible  to  diminish  the  dilution  of  the  milk 
so  rapidly  that  at  the  age  of  five  or  six  months,  pure  cow’s  milk  may 
be  given  without  any  dilution.  [At  six  months  of  age  it  is  permissible 
to  add  home-made  farinaceous  food  made  from  oats  or  barley,  to  be 
given  only  in  solution  and  with  milk.  Oat  jelly  is  made  by  soaking 
four  ounces  of  oat-meal  in  a  quart  of  cold  water  for  twelve  hours,  and 
then  boiling  this  down  to  a  pint,  which  can  be  strained  through  a  fine 
cloth  while  hot.  As  it  cools,  a  jelly  forms  which  is  kept  on  ice  till 
needed,  when  equal  parts  of  the  jelly  can  be  warmed  with  cow’s  milk. 
Barley  jelly  can  be  made  in  the  same  way.] 

Occasional  Inability  of  Infants  to  digest  diluted  Cow’s  Tlilk.- — 
Not  unfrequently  it  happens  that  the  new-born  infant  is  unable  to 
digest  cow’s  milk,  however  much  it  may  be  diluted  with  water  or  barley- 
water.  What  course  is  to  be  then  adopted  ?  Two  alternatives  present 
themselves  in  this  emergency.  The  first  is  to  adopt  some  method  of 
preparing  the  cow’s  milk  so  as  to  make  it  more  easily  digested  than 
when  simply  diluted  with  water  or  barley  -water.  The  other  is  to  resort 
to  the  use  of  some  other  kind  of  milk,  either  that  of  the  ass,  or  of  the 
goat,  or  of  a  wet  nurse. 

The  first  alternative  will  in  general  be  preferred  as  the  more  con¬ 
venient,  and  three  different  methods  of  preparing  milk  for  infants’ 
digestion  are  employed,  which  will  be  described  in  the  order  in  which 
perhaps  they  are  most  frequently  used.  All,  however,  in  varying  cir¬ 
cumstances  are  equally  eligible,  and  individual  preferences  will  not  un¬ 
frequently  decide  the  selection.  If  one  method  is  unsatisfactory  in 
regard  to  the  comfort  and  welfare  of  the  child,  another  must  be 
resorted  to. 

The  milk  prepared  by  the  three  methods  respectively  is  known  as 
humanized  milk,  sterilized  milk,  or  peptonized  milk. 

Humanized  milk  is  simply  cow’s  milk  diluted  with  a  certain 
amount  of  whey,  and  with  some  superadded  cream.  It  is  prepared  in 
the  following  way  :  A  certain  quantity  of  cow’s  milk,  say,  a  pint,  is 
set  aside  in  a  cool  place  until  the  cream  rises  to  the  surface.  This  is 
skimmed  off  and  kept,  and  to  the  milk  remaining  is  added  enough 
essence  of  rennet  to  curdle  it  thoroughly.  The  whey  is  strained  off 
from  the  curd,  added  with  the  cream  previously  separated  to  a  pint  of 
fresh  cow’s  milk,  and  the  mixture  is  known  as  humanized  milk.  It  is 
distinctly  more  digestible  than  ordinary  diluted  milk,  and  often  agrees 
well  with  young  infants,  being  given  without  any  further  dilution  m 
the  quantities  suitable  to  the  age  of  the  infant. 

Sterilized  milk  is  milk  in  which  all  germs  tending  to  decomposi¬ 
tion  have  been  destroyed  by  exposure  to  a  boiling  heat  for  a  short 
period  of  time.  Fresh  cow’s  milk  always  contains  some  impurities 
received  from  the  atmosphere  or  from  the  vessels  in  which  it  is  con-  • 


STERILIZED  MILK. 


147 


tamed,  however  much  care  may  have  been  taken  to  maintain  absolute 
cleanliness.  To  an  infant  with  good  digestion  these  impurities  do  no 
harm,  the  digestive  powers  being  sufficient  to  overcome  their  influence  ; 
but  when  the  digestion  is  feeble,  unhealthy  fermentation  is  frequently 
caused  by  them  in  the  child’s  stomach,  which  becomes  irritated  and 
inflamed,  and  its  powers  further  enfeebled,  while  at  the  same  time  the 
milk  in  the  stomach  is  rendered  by  the  fermentation  still  more  indigesti¬ 
ble.  The  result  to  the  child  is  sickness,  with  vomiting  of  acrid  and 
sour-smelling  curdled  milk,  followed  frequently  by  diarrhoea  of  an 
offensive  character,  with  rapid  wasting  of  body  and  loss  of  strength. 
Chemical  and  microscopical  analysis  has  demonstrated  that  this  un¬ 
healthy  fermentation  is  due  to  the  presence  of  small  germs  introduced 
with  the  impurities,  and  it  has  been  discovered  that  those  germs  can  be 
destroyed  by  exposing  the  milk  for  thirty  to  forty  minutes  to  a  tem¬ 
perature  equal  to  the  boiling-point  of  water,  and  that  when  the  germs 
are  so  destroyed  the  milk  does  not  ferment  or  decompose.  The  process 
of  destroying  the  germs  is  known  as  the  sterilizing  of  the  milk,  and  is 
carried  out  in  the  following  way  :  An  apparatus  for  the  purpose  is 
necessary,  which  consists  essentially  of  one  dozen  to  twenty  feeding- 
bottles,  each  capable  of  containing  from  four  to  five  fluid  ounces  of 
milk,  india-rubber  and  glass  stoppers  for  these  bottles,  a  tin  saucepan 
with  lid  to  be  used  for  boiling,  and  a  frame  for  holding  the  bottles  when 
placed  in  the  water  in  the  saucepan.  Some  india-rubber  nipples  to  be 
fitted  on  to  the  bottles  for  the  convenience  of  the  baby  accompany  the 
apparatus,  and  various  little  arrangements  to  assist  in  cleanliness. 

The  bottles  are  filled  up  to  the  neck  with  fresh  cow’s  milk  diluted 
with  water  or  with  barley-water  to  the  extent  desired,  partially 
stoppered  with  india-rubber  stoppers  perforated  through  the  centre, 
and  placed,  arranged  in  the  frame,  in  the  saucepan,  which  is  filled 
with  cold  water  until  the  bottles  are  almost  entirely  covered.  The 
saucepan  is  covered  and  placed  on  the  fire,  and  the  water  is  raised  to 
the.  boiling-point,  and  kept  boiling  for  about  five  minutes.  The  lid  of 
the  saucepan  is  then  taken  off,  and  the  perforated  openings  in  the  cen¬ 
tre  of  the  india-rubber  stoppers  closed  by  the  insertion  of  the  glass 
stoppers,  which  should  be  dipped  in  the  boiling  wrater  before  being 
pushed  into  the  india-rubber  stoppers.  The  lid  of  the  saucepan  is  then 
replaced,  and  the  boiling  continued  for  thirty-five  or  forty  minutes. 
The  milk  is  by  this  subjection  to  boiling  heat  thoroughly  sterilized, 
and  the  bottles  are  removed  from  the  saucepan,  and  put  aside  until  re¬ 
quired  for  the  use  of  the  infant.  They  should  be  kept  in  a  moderately 
cool  place.  If  this  is  done,  it  is  said  that  the  milk  will  keep  perfectly 
fresh  for  three  or  four  weeks.  It  is  undesirable  under  ordinary  cir¬ 
cumstances  to  make  any  experiment  in  this  direction,  and  it  will 
generally  be  found  satisfactory  to  sterilize  only  enough  at  a  time  to 


148 


THE  NUTRITION  OF  THE  CHILD. 


serve  for  twenty-four  hours.  To  feed  the  infant,  one  of  the  bottles  is 
taken  and  placed  for  a  few  minutes  in  water  as  hot  as  the  hand  will 
bear  comfortably,  until  the  milk  in  it  is  properly  warmed  ;  the  india- 
rubber  and  glass  stoppers  are  then  removed,  and  an  india-rubber  nipple 
attached  to  the  neck  of  the  bottle,  from  which  the  baby  draws  directly 
the  sterilized  milk.  A  fresh  bottle  must  always  be  open  for  each  meal ; 
if  anything  is  left  in  it  after  the  baby  is  finished,  it  should  be 
thrown  out. 

It  will  be  seen  from  the  description  given  that  when  the  apparatus 
has  been  obtained,  the  process  of  sterilizing  the  milk  is  very  simple  and 
cas}7-.  The  one  difficulty  is  found  in  maintaining  in  perfect  cleanliness 
the  bottles,  stoppers,  and  nipples.  Directions  about  cleaning  generally 
accompany  the  apparatus,  and  much  attention  must  be  given  to  their 
fulfilment,  as  upon  cleanliness  depends  the  whole  success  of  the 
sterilization. 

[Sterilized  milk  may  be  obtained  ready-made  in  New  York  and 
some  other  cities,  but  that  which  has  been  so  highly  heated  as  to  keep 
fresh  for  several  weeks  is  found  to  have  lost  something  of  its  digest¬ 
ibility  and  fitness  for  nutrition.  While  the  sterilizing  process  is  em¬ 
ployed  in  the  making  of  “modified  milk,”  previously  described,  the 
temperature  is  not  raised  to  the  boiling-point,  and  the  milk  is  not  pre¬ 
served  by  high  heat  to  keep  very  long  without  change.  Raw  milk  is 
more  digestible  than  boiled  milk ;  or,  heat  that  kills  out  all  ferments 
destroys  at  least  one  that  is  desirable.] 

Peptonized  milk,  the  third  substitute  for  ordinary  diluted  milk 
when  difficulties  of  digestion  present  themselves  in  young  infants,  is  as 
simple  of  preparation  as  sterilized  milk,  and  has  the  advantage  of  not 
calling  for  any  apparatus.  It  consists  of  milk  which  has  been  partially 
predigested  by  the  addition  of  some  preparation  of  digestive  ferment, 
obtainable  from  most  pharmacists.  The  milk  should  be  diluted  to 
some  extent  before  being  peptonized,  but  it  is  not  usually  necessary  to 
dilute  it  to  such  an  extent  as  has  been  recommended  for  ordinary  cow’s 
milk.  Generally,  even  for  an  infant  of  two  or  three  days  old,  the  ad¬ 
dition  of  an  equal  quantity  of  water  or  barley-water  will  be  sufficient ; 
and  when  a  baby  is  two  or  three  months  old  a  dilution  of  two  parts  of 
milk  with  one  of  water  will  be  digested  with  comfort.  It  is  best  to 
peptonize  at  one  time  only  enough  for  one  meal,  although  in  emergency 
enough  can  be  prepared  to  last  for  twenty-four  hours. 

The  milk,  diluted  to  the  extent  desired,  is  placed  in  a  bottle  or  jug, 
and  the  powder  mixed  with  it.  It  is  then  allowed  to  stand  in  water  as 
hot  as  can  be  borne  by  the  hand  for  from  ten  minutes  to  twenty 
minutes,  when  the  peptonization  is  complete.  If  a  bottle  has  been 
used,  it  may  be  given  to  the  baby  at  once  without  further  preparation 
If  a  jug  or  other  receptacle  has  been  used,  sufficient  milk  for  one  meal 


PEPTONIZED  MILK. 


149 


is  poured  irto  a  bottle  and  given  to  the  infant  immediately;  what 
remains  must  be  put  in  a  saucepan  and  boiled  for  four  or  five  minutes 
to  arrest  the  further  progress  of  the  peptonization.  It  may  then  be 
left  in  a  cool  place  for  twelve  to  twenty-four  hours  if  necessary,  and 
simply  heated  by  being  placed  in  warm  water  before  being  administered. 

The  degree  of  peptonization,  and  the  consequent  assistance  given 
to  the  digestive  power  of  the  infant,  depend  upon  the  length  of  time 
the  milk  is  subjected  to  the  influence  of  the  powder,  the  peptonizing 
process  continuing  until  arrested  by  boiling.  Generally  it  will  be 
found  that  peptonizing  for  ten  minutes  or  a  quarter  of  an  hour  gives 
sufficient  aid  to  the  weakened  digestion  of  the  child.  If  the  process  is 
allowed  to  go  on  for  much  more  than  twenty  minutes,  or  if  too  much 
of  the  peptonizing  agent  is  used,  the  milk  becomes  bitter  in  taste,  and 
somewhat  curdled,  and  the  infant  may  dislike  and  refuse  to  take  it. 

When  the  peptonized  milk  is  to  be  kept,  the  boiling,  to  arrest  the 
fermentation,  must  be  continued  for  about  five  minutes  ;  it  is  not  suf¬ 
ficient  simply  to  raise  the  milk  to  the  boiling-point. 

A  minute  comparison  of  the  merits  of  the  different  preparations 
would  be  out  of  place  here,  but  it  may  be  remarked  that  whereas  the 
humanized  milk  is  most  suitable  for  babies  of  good  health  who  have 
some  difficulty  or  discomfort  in  digesting  ordinary  diluted  milk,  the 
other  two  preparations  will  be  found  of  much  value  when  there  is 
special  feebleness  of  digestion,  whether  or  not  accompanied  by  actual 
irritation  of  the  stomach  and  bowels.  Since  their  introduction,  the 
use  of  the  milk  of  other  animals  in  place  of  cow’s  milk  is  resorted  to 
much  less  frequently,  and  accordingly  very  little  will  require  to  be 
said  with  reference  to  the  milk  of  the  ass  or  the  goat,  although  a  little 
attention  must  be  directed  to  the  employment  in  certain  cases  of  the 
services  of  a  wet-nurse. 

[In  a  large  and  very  recent  work  by  Dr.  T.  M.  Rotch  of  Harvard 
University,  on  the  “Hygienic  and  Medical  Treatment  of  Children,”  he 
thus  writes  of  peptonized  milk  :  “In  many  cases  the  indigestion  is 
attributed  to  a  lack  of  power  to  digest  proteids  (nitrogenous  foods)  at 
all,  while  in  fact  the  stomach  is  simply  rebelling  against  an  excess  of 
them.  It  would  seem  that,  for  the  average  infant,  this  predigestion  is 
contrary  to  Nature’s  teachings.  There  are  certain  natural  functions 
which  should  be  allowed  to  act  as  they  do  on  human  milk,  and  it  seems 
irrational  not  to  encourage  all  the  functions  to  act  naturally,  instead  of 
forestalling  their  action  and  allowing  them  to  fall  into  disuse  and  thus 
be  weakened.  So  far  as  I  know,  no  very  brilliant  results  have  been 
obtained  from  its  use,  except  where  the  infant’s  digestion  has  been  in 
an  abnormal  condition.”] 

Ass’s  milk  approaches  in  character  and  composition  human  milk 
more  nearly  than  that  of  any  other  domestic  animal.  It  is  not  quite  so 


THE  NUTRITION  OP  THE  CHILD. 


150 

rich  in  cream  as  human  milk,  but  resembles  it  very  closely  in  its  other 
constituents  and  in  its  general  appearance,  and,  when  easily  obtainable, 
is  a  very  valuable  substitute  for  it.  It  can  generally  be  taken  by  very 
young  infants  without  dilution,  only  requiring  to  be  warmed  to  the 
proper  temperature.  Unfortunately,  as  a  rule,  it  is  not  easily  obtained, 
and  the  price  is  apt  to  be  somewhat  prohibitive. 

Goat’s  milk  is  not  very  frequently  employed  in  England  as  a 
substitute  for  human  milk.  It  is  a  little  richer,  and  requires  some  dilu¬ 
tion,  although  not  so  much  as  cow’s  milk,  and  it  is  certainly  somewhat 
more  easily  digested  than  ordinary  diluted  cow’s  milk. 

The  Wet=Nurse. — Notwithstanding  the  value  of  these  various  sub¬ 
stitutes  for  the  natural  food  of  an  infant,  instances  occur  not  very  un- 
frequently  where  it  is  proper  to  avail  one’s  self  of  the  services  of  a 
healthy  wet-nurse.  Some  infants  are  intolerant  of  all  kinds  of  artificial 
food,  and  life  itself  may  depend  upon  obtaining  a  wet-nurse  ;  in  other 
cases  some  special  weakness  of  the  infant,  such  as  results  from  prema¬ 
ture  birth,  or  some  constitutional  peculiarity  of  the  mother,  may  dictate 
the  prudence  of  utilizing  a  wet-nurse,  with  a  view  to  the  future  health 
and  well-being  of  the  child.  The  propriety  of  this  will  always  fall  to 
be  decided  by  the  medical  attendant,  who  will  give  his  advice  on  the 
selection  of  the  wet-nurse.  A  mother  must,  in  such  a  case,  be  prepared 
to  overcome  her  reluctance  to  have  her  baby  nursed  by  another  woman. 
The  feeling  is  a  natural  and  a  proper  one,  but  in  consideration  of  the 
fact  that  the  whole  future  of  the  child  may  depend  upon  the  start  it 
makes  during  the  first  six  or  nine  months  of  life,  a  sensible  mother  will 
sacrifice  her  own  inclinations,  and  consent  to  what  she  is  assured  is  for 
the  benefit  of  her  child. 

[A  mother  who  is  nervous,  harassed,  fretful,  grieved,  or  worried 
is  likely  to  produce  a  poor  quality  of  milk,  even  a  poisonous  one  may 
be  ;  and  she  may  wisely  stand  aside  and  let  her  babe  be  nourished  from 
some  placid,  even-tempered  wet-nurse.  The  more  a  mother  can  imitate 
the  quiet,  contented,  and  mild  mannered  mental  status  of  the  cow,  the 
better  fitted  is  she  for  nursing  her  infant.  If  “mental  science”  or  any 
similar  forces  or  influences  can  be  made  available  for  encouraging 
serenity  of  mothers,  it  may  be  very  safely  so  employed.] 

Additions  to  Milk  Diet. — When  babies  fed  by  any  of  the  artificial 
means  just  described  have  attained  the  age  of  six  months,  it  will  probably 
be  desirable  to  add  some  farinaceous  food  [oat  jelly]  to  their  diet, 
being  made  with  the  particular  preparation  of  milk  upon  which  the 
infant  has  been  so  far  reared.  When  peptonized  milk  has  been  used, 
it  is  desirable  now  to  try  to  reduce  somewhat  the  amount  of  peptoniza¬ 
tion.  The  peptonizing  is  intended  to  assist,  not  to  supplant,  the  digest¬ 
ive  powers  of  the  infant  ;  and  when  it  is  six  months  old,  and  in  good 
health,  it  ought  not  to  require  so  much  assistance  as  when  an  infant  of 


SPOON-FEEDING. 


151 

a  few  days  old.  The  diminution  of  the  peptonization  is  best  effected 
by  allowing  the  peptonizing  agent  to  act  for  a  shorter  time,  the  process 
being  arrested  by  boiling  the  milk  for  a  few  minutes,  five  or  ten 
minutes  after  the  powder  has  been  added,  instead  of  being  continued 
for  fifteen  or  twenty  minutes.  When  it  has  been  customary  to  give 
the  peptonized  milk  immediately  after  the  peptonizing,  without  any 
means  having  been  used  to  arrest  the  further  peptonization,  the  re¬ 
duction  is  best  made  by  diminishing  the  quantity  of  the  agent  employed. 

Spoon = Feeding. — After  the  age  of  six  months  it  is  usually  found 
desirable  to  give  some  farinaceous  food  to  babies,  even  when  their 
mothers  have  been  able  to  nurse  them  so  far  without  any  assistance. 
Foods  of  either  of  the  three  classes  mentioned  may  be  used  for  this 
purpose,  being  made  with' cow’s  milk.  It  is  always  best,  when  pos¬ 
sible,  to  dispense  with  the  predigested  foods  ;  and  generally  at  this  period 
of  life  babies  will  take  arrowroot,  corn-flour,  hominy  [or  any  thorough¬ 
ly  cooked  preparations  of  the  cereals],  with  pleasure,  and  without  any 
subsequent  discomfort  or  difficulty  of  digestion.  Food  at  this  age 
should  not  be  given  through  a  bottle ;  the  baby  should  be  taught  to 
feed  from  a  spoon,  and  if  any  milk  is  given  independently  of  the 
mother’s  milk,  the  baby  should  drink  it  from  a  cup.  There  are  two 
advantages  to  the  baby  in  being  fed  with  a  spoon  in  place  of  sucking 
its  food  from  a  bottle.  In  the  first  place,  the  baby  takes  it  more 
slowly,  and  the  food  is  thus  better  mixed  with  the  saliva  of  the  mouth, 
which  assists  in  its  digestion  ;  and  in  the  second  place,  the  food  can  be 
made  thicker  and  more  nutritious.  The  artificial  food  should  be  given 
once  or  twice  daily,  at  an  hour  most  convenient  to  relieve  the  mother 
from  her  duty  of  suckling  the  infant.  In  children  who  have  been 
brought  up  artificially,  some  farinaceous  food  may  be  given  with 
almost  every  meal,  wdiether  ordinary  milk  or  prepared  milk  has  been 
previously  employed.  If  some  malted  food  of  the  third  kind  has  been 
used  hitherto,  this  should  be  varied  once  or  twice  a  day  by  a  food  of 
the  second  class,  and  gradually  the  malted  food  should  be  given  up, 
and  replaced  by  food  of  either  of  the  two  other  classes.  It  is  sometimes 
convenient  and  admissible,  up  to  the  age  of  one  year  or  a  little  beyond, 
to  give  milk  from  a  bottle,  and  predigested  food  may  also  be  given  in 
the  same  way  ;  but  for  other  foods  it  is  alw'ays  best  to  adopt  a  spoon  as 
early  as  possible. 

At  the  age  of  nine  or  ten  months  a  little  animal  food  maybe  com¬ 
menced,  in  the  form  first  of  a  lightly  boiled  egg  every  second  day, 
given  along  with  a  little  thin  bread  and  butter  ;  and  if  this  agrees  fi 
may  be  alternated  with  some  animal  soup,  chicken  and  veal  broth  being 
somewhat  preferable  to  mutton  or  beef  tea,  Thes'e  soups  may  be 
thickened  with  a  little  arrow7 root  or  corn-flour,  or  some  other  farinaceous 
food,  or  they  may  be  given  without  any  addition,  accompanied  with  a 


152 


THE  NUTRITION  OF  THE  CHILD. 


little  bread.  When  eggs  are  found  to  agree  well,  they  may  be  cooked 
in  puddings  with  rice,  tapioca,  or  any  other  of  the  various  forms  of 
starchy  food. 

[Dr.  Rotch  says:  “We  have  in  preparations  of  oats,  both  for 
purposes  of  weaning  and  for  establishing  a  new  variety  of  diet  for  the 
infant,  a  food  which  in  combination  with  cow’s  milk,  satisfies  com¬ 
pletely  the  demands  at  this  period  for  a  perfect  nutriment.  It  is  best 
to  increase  gradually  the  variety  of  articles  of  diet  from  the  twelfth  to 
the  twentieth  month,  always  adapting  the  food  to  the  especial  infant. ' 
Thus,  some  infants  may  be  able  to  digest  proportionately  large  quanti¬ 
ties  of  starch  ;  others  may  need  and  digest  larger  proportions  of  the 
nitrogenous  than  the  infants  just  spoken  of.  Between  the  twelfth  and 
the  thirteenth  month  I  am  in  the  habit  of  giving  the  infant  five  meals 
during  the  day.  By  this  time  it  is  well  to  accustom  it  to  take  its  food 
from  a  spoon,  and  as  soon  as  possible  to  omit  feeding  from  the  bottle. 
The  five  meals  should  be  arranged  as  follows  :  For  breakfast,  bread 
and  cow’s  milk,  slightly  warmed.  For  lunch,  equal  parts  of  oat  jelly 
and  cow’s  milk,  warmed,  with  a  little  salt  added  according  to  the 
infant’s  taste. 

“This  meal  of  oat  jelly  should  be  repeated  in  the  middle  of  the 
afternoon.  In  the  middle  of  the  day,  broth  of  some  kind,  either  chicken 
or  mutton,  carefully  prepared  so  as  to  be  free  from  fat  on  its  surface, 
can  be  given  with  some  bread.  The  fifth  meal  should  be  given  late  in 
the  afternoon,  and  consist  of  bread  and  milk.  When  the  infant  is 
fifteen  months  old  some  thoroughly  boiled  rice  can  be  added  to  the 
broth  in  the  middle  of  the  day,  and  if  it  digests  this  well,  some  bread 
can  also  be  given  at  this  meal.  There  are  not  many  fruits  which  should 
be  given  to  the  infant  in  its  second  year.  A  baked  apple,  or  apple 
sauce  made  without  much  sugar,  can  be  given,  and  when  peaches  are 
in  season,  a  ripe  peach,  especially  if  the  infant  is  inclined  to  constipa¬ 
tion.  Other  fruits  should  be  avoided.”  The  writer  of  this  interpola¬ 
tion  would  beg  to  except  from  this  broad  exclusion  of  fruits  a  baked 
banana,  which  is  certainly  nutritious,  digestible,  and  palatable,  and 
suitable  for  weak  digestions  of  either  young  or  old.  The  well  ripened 
banana  need  only  be  baked  in  an  oven  about  fifteen  minutes,  or  re¬ 
moved  earlier  if  it  splits  with  the  heat.  It  stands  with  a  baked  apple 
as  a  fine  food,  fit  for  a  prince  of  royal  birth  and  yet  cheap  and  easy 
enough  for  even  poor  folks  to  obtain.] 

At  the  age  of  eighteen  months  a  child  is  able  to  masticate  tender  fish, 
fowl,  or  even  beef  or  mutton  without  its  being  previously  minced  ;  and 
a  little  vegetable,  in  the  form  of  mashed  potato,  cauliflower,  spinach, 
or  cabbage  may  be  carefully  added  to  the  diet.  When  two  years  of 
life  are  completed,  the  teeth  are  fully  developed,  and  the  range  of  diet 
may  be  still  further  widened.  [The  above  advice  is  permitted  to  stand 


ERRORS  IN  DIET  OF  INFANTS. 


153 


‘as  it  was  written,”  because  it  probably  fairly  represents  the  average 
professional  opinion,  but  many  physicians  who  think  more  freely  for 
hemselves  are  teaching  that  most  children  may  be  wisely  and  well 
wrought  up  without  any  fowd,  fish,  or  meat ;  that  they  are  decidedly 
better  without  it,  and  if  so  guided  as  to  diet,  will  be  less  liable  to  chil- 
Iren’s  diseases,  better  behaved,  and  more  easily  trained  and  kept  in  the 
svay  they  should  go.  Meats  are  in  fact  stimulating  foods,  and  children 
ire  as  a  rule  better  without  stimulants  of  any  kind.] 

Nerve  Stimulants,  such  as  tea,  coffee,  and  alcoholic  fluids,  should 
nave  no  place  in  the  diet  of  children.  They  exercise  a  distinctly  in¬ 
jurious  immediate  effect  upon  the  digestion,  and  upon  the  exceedingly 
sensitive  nervous  system  ;  and  their  habitual  use  lays  the  foundation  of 
many  nervous  disorders  in  future  life.  The  administration  of  such 
stimulants  is  followed  by  excitement,  irritability,  and  restlessness  at 
night,  and  distaste  for  more  nourishing,  but  less  stimulating  foods  not 
[infrequently  results.  No  alcoholic  preparations  of  any  kind  should  be 
ever  given  to  children  except  under  medical  advice. 

Common  Errors  !n  the  Diet  of  Infants. — There  are  three  different 
directions  in  wdiich  the  diet  of  children  are  apt  to  be  found  to  err : — 

(1)  In  the  first  place,  many  children  suffer  from  a  want  of  suffi¬ 
cient  fatty  food  in  their  diet.  The  constitutional  wants  of  children 
demand  a  considerable  amount  of  fat  in  the  food,  and  this  is  supplied 
in  early  life  by  the  cream  contained  in  the  milk.  If  diluted  cow’s 
milk  is  employed  as  a  substitute  for  mother’s  milk,  the  proportion  of 
cream  in  it  is  considerably  less,  and  unless  the  deficit  is  made  up  in 
some  wrny,  the  child  is  apt  to  suffer  in  health.  While  taking  apparent¬ 
ly  a  sufficient  quantity  of  food,  it  will  appear  thin,  and  the  limbs, 
instead  of  being  rounded  and  chubby,  will  be  flaccid  and  soft.  When 
this  is  observed  in  a  child  otherwise  apparently  healthy,  the  question 
should  abvays  present  itself  as  to  whether  anything  is  wanting  in  the 
diet.  If  the  wTant  is  not  supplied,  the  child  will  continue  in  depressed 
health,  be  very  easily  affected  by  cold,  take  bronchitis  on  slight  ex¬ 
posure,  and  perhaps  wdien  a  year  or  two  old  develop  rickets.  There  is 
not  much  difficulty,  as  a  rule,  in  adequately  supplying  the  deficit.  In 
very  young  life  cream  may  be  added  to  the  milk,  or  a  very  little  cod- 
liver  oil  may  be  given  once  or  twice  daily.  When  the  child  has  passed 
the  age  of  six  months,  a  fair  quantity  of  butter  may  be  given  with 
bread,  or  some  bread  soaked  in  fat  gravy  of  beef. 

(2)  The  second  error  in  the  diet  of  children,  and  perhaps  the  most 
frequent  of  the  three,  is  the  administration  of  farinaceous  food  in 
excess.  Under  no  circumstances  can  farinaceous  food  take  the  place 
of  milk,  although  it  is  valuable  as  an  addition  to  it.  The  milk  contains 
certain  chemical  constituents  called  azotes,  which  are  absolutely  neces¬ 
sary  for  the  proper  nourishment  of  the  body,  and  w^hich  are  found  only 


154 


THE  NUTRITION  OF  THE  CHILI). 


in  very  minute  quantities  in  farinaceous  food.  They  exist  to  a  much 
greater  extent  in  animal  soups,  and  these  can  occasionally  be  made  to 
supply  for  a  little  time,  in  conjunction  with  farinaceous  foods,  the  place 
of  milk  ;  but  even  in  these  soups  the  quantity  of  azotes  is  much  below 
the  requirements  of  an  infant’s  frame.  When  farinaceous  food  is  given 
in  excess,  the  digestion  of  the  child  becomes  irritable,  the  bowels  tend 
to  be  lax,  and  the  motions  smell  unpleasantly  ;  sickness  is  apt  to  occur, 
the  night’s  rest  is  disturbed,  and  there  is  a  tendency  to  eczematous 
affections  of  the  skin.  When  the  excess  of  farinaceous  food  is  accom¬ 
panied  by  a  deficit  of  the  nitrogenous  food  in  the  form  of  milk,  the 
infant  becomes  thin,  and  the  face  looks  pinched  and  weary.  The 
remedy  is  simple,  consisting  in  reducing  the  quantity  of  farinaceous 
food,  increasing  the  amount  of  milk  so  far  as  the  digestive  powers  of 
the  child  will  permit,  and  adding  other  nitrogenous  foods,  such  as 
eggs,  when  the  baby  has  attained  an  age  at  which  these  can  be  given 
with  advantage. 

(3)  The  third  error  is  one  not  met  with  usually  until  after  the  first 
year  of  life,  and  consists  of  giving  the  child  a  diet  too  highly  nitro¬ 
genous.  This  error  is  very  improbable  so  long  as  the  only  nitrogenous 
food  given  to  the  baby  is  milk  ;  but  when  eggs,  soups,  and  minced  fish 
and  fowl  are  added  to  the  diet,  it  is  not  unfrequent  to  find  the  child 
suffering  from  an  excess  of  azotes.  Such  children  usually  tend  to 
stoutness,  and  are  apt  to  become  somewhat  yellow  and  slightly  jaun¬ 
diced  occasionally ;  the  whites  of  the  eyes  lose  their  clearness,  the 
bowels  tend  to  be  confined,  and  the  urine  to  be  high-colored  and  dis¬ 
agreeable  in  smell,  with  an  occasional  sediment  in  it.  Disturbed  sleep 
is  common,  and  grinding  of  the  teeth  at  night  ;  and  an  eczematous 
eruption  may  occur,  situated  most  frequently  in  the  folds  of  the  elbows 
and  knees.  The  remedy  is  obvious  ;  and  it  need  only  be  remarked  that 
no  healthy  child  under  the  age  office  years  will  ever  suffer  from  a  restric¬ 
tion  of  animal  food  so  long  as  it  obtains  a  full  quantity  of  milk  and  cream , 
and  a  fair  allowance  of  digestible  farinaceous  food. 

The  striking  peculiarity  of  the  digestive  organs  of  children 
as  compared  with  those  of  adults  is  the  facility  with  which  they  be¬ 
come  irritated  and  inflamed.  The  ingestion  of  one  meal  of  an  improper 
character  is  quite  sufficient  to  set  up  inflammation  of  the  lining  mem¬ 
brane  of  the  stomach  and  bowels  which  will  continue  for  days,  and 
may  enfeeble  the  digestion  for  weeks.  Fortunately,  a  safeguard  is 
provided  in  the  facility  with  which  vomiting  is  provoked  in  children, 
an  indigestible  article  of  food  being  frequently  vomited  before  it  has 
had  time  to  create  much  disturbance.  But  this  will  not  always  occur, 
and  such  small  alterations  as  the  very  slightest  sourness  of  milk,  such 
as  might  result  from  leaving  it  for  a  little  while  in  a  dirty  bottle,  slight 
rancidity  of  butter,  or  some  want  of  freshness  in  fish,  too  minute  to 


THE  NUTRITION  OP  THE  CHILD. 


155 


be  detected  by  the  senses  of  the  parent,  may  be  sufficient  to  set  up 
acute  irritation  of  the  stomach  and  bowels  of  the  child.  No  time  is 
better  spent  by  a  mother  than  that  which  is  devoted  to  seeing  that  the 
meals  of  the  child  are  properly  prepared  and  carefully  administered. 


I 


CHAPTER  XIV. 


I 


Physical  and  Mental  Training  of  the  Child. 

Object  aimed  at;  Necessity  of  Training  Faculties;  Results  of  Disuse;  Relation 
between  Body  and  Mind ;  Importance  of  Maintenance  of  Health  and  Devel¬ 
opment  of  Function;  Variations  in  Different  Children  due  to  Want  of 
Training;  Dread  of  Undue  Strain;  Value  of  Effort  alternating  with  Rest ; 
Necessity  of  Care  against  unduly  Severe  or  Prolonged  Strain;  Spontaneous 
Tendency  to  Movement;  Artificial  Means  of  Exercise;  Swinging;  Military 
Drill;  Musical  Calisthenics;  Dancing;  Importance  of  Regularity  in  Exer 
cise;  Necessity  of  Due  Rest;  Training  of  Special  Senses;  Mental  Training; 
Risk  of  Overwork;  Relation  between  Fatigue  and  Want  of  Interest;  Moral 
Training. 

In  the  cultivation  of  the  physical  and  mental  powers  of  a  child,  it 
is  necessary  to  keep  in  view  the  object  aimed  at,  as  a  guide  to  the 
means  to  be  adopted.  That  object  ought  to  be  the  development  to 
the  highest  possible  extent  of  the  various  faculties  with  which  the 
child  is  endowed  at  birth,  and  the  discovery  and  cultivation  of  any 
specially  valuable  tendency  which  it  may  have  inherited  from  past 
generations.  Both  mental  and  physical  powers  require  to  be  exercised 
and  trained  before  they  can  be  utilized  in  the  work  of  life,  and  disuse 
of  any  mental  faculty  is  followed  by  feebleness  and  atrophy  of  the 
particular  part  of  the  mind  involved,  quite  as  inevitably  as  want  of 
exercise  of  any  particular  muscle  results  in  its  wasting  and  loss  of 
power.  The  physical  and  mental  powers  also  are  correlated  in  such  a 
way  that  it  is  very  seldom  that  good  mental  work  can  be  done  in  the 
absence  of  a  fair  degree  of  physical  health  ;  the  converse,  that  mental 
development  is  essential  for  the  due  performance  of  physical  functions 
is,  perhaps,  not  so  universally  apparent,  although  in  some  sense  it  is 
also  true. 

It  follows  naturally  from  this  that  from  early  life  attention  should 
be  directed  specially  to  the  maintenance  of  the  various  organs  of  the  body 
in  perfect  health,  and  to  their  due  functional  development.  The  muscular 
system  has  to  be  exercised,  so  that  the  muscles  may  perform  their 
work  well  and  quickly,  and  with  proper  balance  and  accuracy  ;  and 
the  control  of  the  muscles  by  the  nervous  system  should  be  cultivated 
by  exercises  involving  due  rhythm  and  harmony  between  different 
parts  of  the  body.  The  organs  of  special  sense,  more  especially  those 

15ft 


x-.  U:,t//o.C: ten. 


FIRST  STEPS 


ALL  FUNCTIONS  DEVELOP  BY  USE. 


157 


of  sight -and  hearing,  are  capable  of  great  development,  and  call  for 
special  attention.  Nothing  is  more  striking  than  the  variations  in  the 
faculty  of  observation  noticeable  among  children.  In  looking  at  a 
flower,  for  instance,  one  child  will  see  nothing  but  a  mass  of  color, 
while  another  of  similar  age  will  note  different  shades  of  color,  differ¬ 
ent  shapes  of  leaves,  and  minute  peculiarities  of  structure.  Natural  abil¬ 
ity,  of  perhaps  more  properly  inherited  qualities,  may  account  for  a  part 
of  this  difference,  but  it  may  generally  be  assumed  that  in  some  way  or 
another  the  powTer  of  observation  has  been  more  highly  educated  in  the 
one  child  than  in  the  other. 

Effort  and  Rest. — There  not  unfrequently  exists  a  rather  ex¬ 
aggerated  dread  of  putting  too  much  strain  upon  the  faculties  of  chil¬ 
dren.  But  all  experience  points  to  the  fact  that  education  and  develop¬ 
ment,  both  of  bodily  and  mental  functions,  is  best  promoted  by  a  series 
of  efforts  alternating  with  periods  of  rest.  It  is  not  by  steady  and  con¬ 
tinuous  hard  work  that  the  muscles  of  the  athlete  are  trained  to  their 
extreme  power  ;  it  is  by  occasional  severe  exercise  followed  by  relaxa¬ 
tion,  by  the  excitement  of  contest,  alternating  with  the  repose  of 
achievement.  Nor  are  the  highest  mental  attainments  usually  associa¬ 
ted  with  continuous  plodding  work  ;  the  triumphs  of  oratory  of  the 
statesman  and  barrister  are  followed  by  periods  of  recreation  and  men¬ 
tal  relaxation  ;  the  strain  upon  the  mind  of  the  successful  mathema¬ 
tician  or  philosopher  must  be  limited  in  duration,  and  replaced  by 
some  totally  different  variety  of  occupation.  There  is  no  doubt  at  the 
base  of  this  feeling  a  grain  of  truth  in  the  fact  that  the  strain  may  be 
too  severe,  or  may  be  unduly  prolonged.  It  is  this  matter  that  the 
propriety  of  due  regulation  and  progressive  advancement  of  different 
exercises  for  the  body  and  mind  falls  to  be  indicated  and  insisted  upon. 
But  the  possibility  of  overdoing  anything  is  no  reason  for  its  not  being 
done  at  all.  The  result  would  scarcely  be  satisfactory  if  every  child 
were  starved  on  account  of  a  dread  of  the  results  following  from  over- 
indulgence  in  food.  During  the  first  few  years  of  life  the  spontane¬ 
ous  tendency  to  movement  of  every  healthy  child  is  sufficient  train¬ 
ing  for  the  muscular  system.  Every  child  in  normal  health  is  ambi¬ 
tious  oUwalking  and  running,  and  its  efforts  in  acquiring  these  powers 
exercise  fully  not  only  the  muscles  of  the  legs  but  also  those  of  the 
arms  and  back  ;  and  in  the  breathlessness  produced  by  exertion  the 
lungs  and  the  heart  also  receive  tone  and  are  strengthened.  When  a 
child  is  able  to  walk  well,  it  usually  commences  to  climb  on  chairs 
and  beds,  and  in  this  wray  develops  specially  the  muscles  of  its  arms. 
At  this  stage  of  activity,  when  all  experience  is  new,  all  the  special 
senses  are  called  into  requisition,  the  eyes  and  ears  being  always  on 
the  alert  when  the  child  is  awake,  and  the  senses  of  smell,  touch,  and 
especially  taste,  being  almost  continuously  exercised. 


I58  physical  and  mental  training  of  child. 

Artificial  Means  of  Exercise. — As  the  child  becomes  somewhat 
older,  reaching  the  age  of  four  or  five  years,  artificial  means  of  exercise 
should  be  used  to  further  develop  the  muscles  and  strengthen  the 
frame.  Where  available,  swinging  on  a  low  swing  is  a  very  useful 
exercise,  strengthening  the  arms  and  developing  the  chest  at  the  same 
time  that  training  is  given  to  the  muscles  of  the  body  in  maintaining 
the  balance.  Hanging  on  a  trapeze  with  the  hands  for  a  short  time 
morning  and  evening  is  very  valuable  in  developing  the  muscles  of  the 
chest  and  back  as  well  as  of  the  arms,  and  has  the  advantage  over 
swinging  of  being  quite  free  from  risk  of  accident.  ITilitary  drill  is  now 
introduced  into  most  children’s  schools,  with  marked  beneficial  effects 
on  the  development  of  their  chests,  giving  them  by  this  enlargement 
increased  breathing  power,  and  consequent  general  invigoration  of 
health.  Somewhat  similar  to  this,  but  even  more  beneficial,  are  the 
calisthenics  to  the  accompaniment  of  music  which  have  lately  become 
popular.  Hands  and  feet,  arms  and  legs  and  bodies  are  taught  to  act 
in  harmony,  while  at  the  same  time  the  eye  and  the  ear  are  trained  to 
accuracy  of  sight  and  sound.  When  the  music  is  produced  by  the 
vocal  efforts  of  the  children  singing  rhymed  words  to  simple  tunes,  no 
better  physical  training  can  be  imagined,  and  very  few  indeed  can  be 
productive  of  more  pleasure  to  the  children.  In  the  same  category  of 
exercises,  although  not  of  quite  so  much  value,  may  be  placed  dancing. 
It  is  quite  a  mistake  for  parents  to  consider  those  exercises  as  only 
amusements.  Amusements,  fortunately,  they  are  to  the  children, 
but  they  are  of  inestimable  value  in  maintaining  the  health  of  the 
body,  and  have  a  distinctly  beneficial  effect  on  the  mental  condition, 
even  apart  and  beyond  what  is  due  to  the  satisfactory  physical 
well-being.  More  especially  to  girls  from  the  age  of  five  to  fifteen, 
who  are  often  deprived  by  custom  of  many  of  the  physical  recrea¬ 
tions  enjoyed  by  boys,  those  various  muscular  exercises  are  of  prime 
importance. 

Developing  as  they  all  do  the  breathing-powers,  and  necessitating 
deep  respiration,  it  is  scarcely  necessary  to  point  out  the  propriety  of 
their  being  carried  out  in  a  pure  atmosphere,  in  order  that  the  great¬ 
est  amount  of  benefit  may  be  derived  from  them.  Where  possible,  it 
is  best  that  they  should  be  conducted  in  the  open  air.  Exercises  of 
this  kind,  to  be  thoroughly  useful,  should  always  be  practised  regularly 
and  at  frequent  intervals.  The  devotion  of  half  an  hour  or  an  hour 
once  or  twice  weekly  to  drill  or  calisthenics  is  of  incomparably  less 
value  than  their  practice  for  a  quarter  of  an  hour  daily.  The  rule 
which  exists  now  in  most  boys’  public  schools,  of  insisting  on  every 
boy  taking  part  daily  in  the  recreations  and  games  of  the  school,  unless 
specially  exempted  by  medical  order,  is  a  sound  one  from  a  physio¬ 
logical  point  of  view, 


CAUSES  OF  SPINAL  CURVATURE. 


159 


Other  exercises  of  much  value  in  the  development  of  the  muscular 
system  are  riding  and  swimming,  while,  for  the  utilization  of  the  lungs 
to  their  full  extent,  nothing  is  better  than  singing,  especially  in  part 
songs. 

Importance  of  Rest. — While  the  muscular  system  is  thus  exer¬ 
cised,  care  must  be  taken  to  insure  due  rest  at  intervals.  Much  harm  is 
sometimes  done  by  forgetting  the  fact  that  sitting  upright  without  any 
support  to  the  back  gives  no  rest  whatever  to  the  muscles  which  sup¬ 
port  the  body,  and  in  fact  puts  additional  strain  upon  them. 

In  the  case  of  girls  especially,  whose  frames  are  not  so  strong  as 
those  of  boys,  curvature  of  the  spine,  with  projection  of  shoulder- 
blades  and  inequality  in  the  height  of  the  shoulders,  is  frequently  the 
result  of  sitting  without'  support  for  the  back  during  the  hours  of 
school.  The  strain  upon  the  muscles  of  the  back  in  such  cases  pro¬ 
duces  discomfort,  which  the  girl  attempts  to  relieve  by  sitting  in  a 
posture  which  throws  the  weight  more  upon  the  bones  and  ligaments 
than  upon  the  muscles ;  the  spine,  losing  the  proper  support  of  the 
muscles,  becomes  curved  to  one  side  or  the  other,  usually  assuming 
more  or  less  the  form  of  the  letter  S,  and  in  time  the  small  bones  form¬ 
ing  the  spine  alter  in  shape,  and  permanent  deformity  results.  Girls 
whose  muscles  are  becoming  thus  weakened  and  unable  to  support  the 
body  properly,  can  generally  be  recognized  when  standing,  by  their 
resting  the  weight  of  the  body  more  on  one  leg  than  on  the  other,  and 
leaning  slightly  over  toward  the  supported  side.  A  habitual  attitude 
of  that  kind  when  standing  should  always  excite  suspicion  of  commenc¬ 
ing  muscular  weakness,  and  indicate  the  propriety  of  regulated  exer¬ 
cise  to  strengthen,  and  regulated  rest  to  restore,  the  fatigued  muscles. 
At  the  period  of  life  in  girls  from  twelve  to  fifteen,  when  an  additional 
tax  is  put  upon  their  strength  by  alterations  already  described  in 
Chapter  XI.,  it  is  absolute  cruelty  to  expect  them  to  sit  at  lessons 
for  two  or  three  hours  daily,  without  proper  support  for  their  backs. 
And  this  is  not  afforded  even  by  chairs  with  backs,  unless  the  backs 
slope  outward  at  a  moderate  angle  from  the  chair.  An  absolutely 
upright  back  is  almost  valueless ;  the  back  of  the  chair  should  slope 
at  suclu  an  angle  as  to  afford  some  support  for  the  spine  along  its 
whole  length. 

Curvature  of  the  spine  is  not  the  only  penalty  which  neglect  of 
these  considerations  exacts.  The  initial  curvature  of  the  spine  is  fre¬ 
quently  followed  by  contraction  of  the  chest  and  diminution  of  the 
breathing  space,  and  in  the  end  permanent  deterioration  of  health  may 
ensue.  Localized  muscular  fatigue  is  also  not  unfrequently  the  cause 
of  emotional  outbursts,  and  many  of  the  so-called  hysterical  attacks  in 
girls  may  be  traced  to  some  unfair  tax  which  has  been  imposed  on  the 
muscular  system. 


! (3o  PHYSICAL  AND  MENTAL  TRAINING  OF  CHILD. 

The  Training  of  the  Special  Senses.— With  regard  to  this,  it  is 
impossible  here  to  do  more  than  indicate  some  useful  methods.  The 
practice  of  games  in  which  rapid  recognition  of  colors  and  pictures  is 
required,  or  where  rapid  enumeration  of  marks  is  called  for,  is  valuable 
in  training  the  eye  to  quickness  and  accuracy.  The  interest  of  children 
is  easily  excited  in  the  recognition  of  common  plants,  in  the  shapes  and 
colors  of  their  leaves  and  flowers  ;  a  taste  for  natural  science  may  thus 
be  aroused,  while  at  the  same  time  the  sense  of  sight  is  cultivated. 

The  sense  of  hearing  can  be  educated  by  games  in  which  rapid 
association  of  sound  with  action  is  called  for.  Children  living  in  the 
country  should  be  induced  to  differentiate  the  voices  of  the  singing 
birds,  and  to  distinguish  other  sounds  of  rural  life.  When  any  musical 
appreciation  exists,  singing  should  be  taught,  and  opportunities  for 
hearing  music  afforded. 

The  sense  of  touch  and  what  is  known  as  the  muscular  sense  are 
developed  best  by  training  in  manual  employments,  such  as  carpenter 
work  and  turning  for  boys,  and  sewing,  knitting,  and  fancy  work 
for  girls. 

Mental  Training  of  Children. — There  is  no  risk  in  the  present 
day  of  this  being  neglected.  The  tendency  is  distinctly  toward  over¬ 
pressure,  and  what  is  called  for  is  more  warning  of  the  evil  effects  of 
over-taxing  the  brain  than  admonitions  with  regard  to  its  due  culture. 
Although  the  results  of  over-fatigue  of  the  brain  are  not  so  immediately 
obvious  as  those  of  over-strain  o4  the  muscular  system,  they  are  proba¬ 
bly  equally  injurious,  and  of  quite  as  permanent  a  character.  The 
practice  which  exists  in  many  schools  of  giving  out  home  lessons  to  be 
finished  when  the  school  hours  are  over,  is  responsible  for  much  injury 
to  the  health  both  of  boys  and  girls.  The  brain,  like  the  rest  of  the 
body,  becomes  somewhat  fatigued  toward  night,  and  resents  being 
called  upon  to  make  exertion  at  a  time  when  it  should  be  preparing  for 
rest.  The  result  is  often  restless  sleep  followed  by  fatigue  and  irrita¬ 
bility  on  waking ;  and  tae  natural  sequence,  impairment  of  digestion, 
and  general  deterioration  of  health.  In  brain  work,  more  conspicuously 
even  than  in  muscular  work,  the  principle  laid  down  early  in  this 
chapter,  of  effort  succeeded  by  rest,  calls  for  full  recognition.  Close 
attention  and  real  work  are  possible  for  two  or  three  hours  daily  if  this 
period  is  succeeded  by  mental  rest  and  recreation  ;  but  if  the  time 
which  should  be  given  to  those  is  occupied  by  home  lessons,  the  in¬ 
evitable  result  is  carelessness  and  want  of  attention  during  school  hours, 
and  mental  progress,  so  far  from  being  expedited,  is  retarded. 

A  Rule  of  Universal  Application  is  that  fatigue  is  not  nearly  so 
easily  induced  when  the  exercise,  be  it  physical  or  mental,  is  pleasur¬ 
able  and  suited  to  the  taste,  as  when  it  is  disagreeable  and  distasteful. 
An  illustration  on  the  physical  side  is  afforded  by  the  distance  which 


MAKE  EXERCISES  AND  STUDY  INVITING. 


161 


can  be  covered  without  fatigue  in  walking  with  a  pleasant  companion, 
or  through  a  picturesque  country,  as  compared  with  that  by  which 
fatigue  is  induced  if  one  is  solitary,  or  if  the  walk  be  uninteresting. 

It  should  therefore,  as  education  progresses,  be  made  an  object  to  dis 
cover  the  particular  tastes  and  tendencies  of  boys  and  girls,  and  to  cul¬ 
tivate  those,  in  preference  to  following  studies  which  are  disliked  ;  as 
in  this  way  the  greater  strain  can  be  put  on  the  mental  faculties  with¬ 
out  fatigue,  and  the  better  results  accordingly  secured.  Most  boys  and 
girls  have  some  favorite  study.  When  this  is  discovered,  opportunity 
for  following  it  should  always  if  possible  be  afforded,  even  although 
the  study  may  not  commend  itself  to  the  parent  or  guardian  as  the 
most  useful,  or  the  one  most  calculated  to  insure  success  in  after  life. 

#  A 

Any  study  which  is  followed  out  with  thoroughness  and  enthusiasm  is 
of  immense  value  in  training  the  mind,  even  when  it  cannot  always  be 
considered  as  advantageous  from  a  “paying”  point  of  view. 

Formation  of  Moral  Character. — It  "would  be  out  of  place  to  say 
much  here  about  the  moral  training  of  children.  This  must  depend 
upon  their  parents,  their  teachers,  their  companions,  and,  to  some 
extent,  their  books.  Judicious  parents  will  always  exercise  due  su¬ 
pervision  over  the  companions  with  whom  their  children  associate,  and 
the  books  which  occupy  part  of  their  leisure  hours.  It  is  in  early  life 
that  the  foundation  of  future  character  is  laid  ;  and  it  should  always 
be  borne  in  mind  that  the  force  of  example  is  infinitely  stronger  than 
the  influence  of  precept  or  doctrine.  Parents  and  teachers  can  scarcely 
expect  to  find  in  their  children  and  pupils  virtues  of  the  possession  of 
which  they  themselves  afford  no  evidence. 


S 

Ik 


CHAPTER  XV 


Some  Congenital  Defects  in  Children. 

“Mothers’  Marks’’;  Cause;  Treatment;  Club-Foot;  Hair-Lip;  Supernumer¬ 
ary  Fingers  and  Toes;  Hernia:  Umbilical,  Inguinal;  Hernia  in  Middle  Line 
of  Abdomen;  Imperforate  Lachrymal  Ducts;  Liability  to  be  Mistaken  for 
Inflammation;  Imperfections  of  Sight;  Short-sight;  Long-sight;  Astigma¬ 
tism;  Squinting,  Curability;  Detection  of  Short-sight;  Of  Astigmatism. 

While  the  vast  majority  of  children  are  born  with  bodies  practically 
perfect  in  structure,  a  small  proportion  are  found  to  exhibit  imperfec¬ 
tions  of  different  kinds,  some  of  which  are  remediable  by  surgical  or 
other  means.  Attention  will  be  called  in  this  chapter  to  some  of  those 
defects  capable  of  remedy,  their  appearance  will  be  described,  and  the 
propriety  of  steps  being  adopted  for  their  relief  will  be  indicated. 

Naevi. — Among  the  most  common  imperfections  of  young  infants 
is  the  presence  on  the  skin  of  what  are  known  popularly  as  mothers' 
marks,  and  scientifically  as  navi.  A  mother’s  mark  or  naevus  appears 
as  a  red  or  purplish  patch  upon  the  skin,  sometimes  elevated,  some¬ 
times  on  the  same  level  as  the  healthy  skin  around.  Nsevi  vary  very 
much  in  size,  being  seen  as  small  as  a  split  pea,  while  they  occa¬ 
sionally  extend  over  a  considerable  part  of  the  body.  Most  com¬ 
monly  they  are  about  the  size  of  a  sixpenny  bit  or  a  shilling 
[a  dime  or  a  quarter  dollar].  Sometimes  their  edge  is  sharply 
defined  ;  at  other  times  the  edges  are  indented,  and  little  processes 
are  thrown  out  like  the  straggling  legs  of  a  spider.  They  result 
from  an  abnormal  enlargement  of  the  superficial  blood-vessels,  and  can 
often  be  made  partially  to  disappear  by  pressure  being  applied  to  them, 
returning  when  the  pressure  is  removed.  There  is  a  popular  belief 
that  they  are  frequently  caused  by  some  vivid  impression  which  has 
been  made  on  the  mother  before  the  birth  of  the  child  ;  and  they  are 
sometimes  supposed  to  represent  the  outline  of  some  animal  or  other 
object  which  may  have  caused  alarm  to  the  mother.  It  is  this  supposi¬ 
tion  which  has  gained  for  them  the  name  of  mothers’  marks,  but  it  is 
exceedingly  doubtful  if  there  is  any  real  foundation  for  this  hypothesis. 
The  smaller  nsevi  are  usually  cured  without  much  difficulty,  and  it  is 
desirable  that  they  should  be  dealt  with  in  the  first  few  months  of  life, 

especially  if  they  are  seen  to  be  increasing  in  size,  as  they  are  somewhat 

163 


DEFORMITY  OF  THE  FEET. 


163 

prone  to  clo.  Frequently  they  are  destroyed  satisfactorily  by  perform¬ 
ing  vaccination  upon  them  ;  if  this  is  not  convenient,  they  can  be  re¬ 
moved  by  burning  with  strong  nitric  acid,  the  pain  of  the  application 
of  which  only  lasts  for  one  or  two  minutes.  The  larger  ones  require 
rather  more  elaborate  surgical  treatment,  but  can  generally  be  removed 
without  any  very  unsightly  cicatrix  being  left  behind.  It  is  always 
well  to  have  them  removed  when  possible,  as  in  the  first  place  they 
generally  tend  to  grow,  and  may  become  dangerously  large,  and  in  the 
second  place,  when  on  any  part  of  the  body  exposed  to  view  they  are 
very  unsightly.  It  is  only  the  very  small  ones  which  ever  disappear 
spontaneously,  and  even  with  these  disappearance  without  treatment 
is  rare. 

Fio.  23. 


TWO  FORMS  OF  CLUB-FEET. 


[  The  use  of  strong  acids,  such  as  nitric,  named  above,  had  better 
be  left  to  surgeons.  For  “home  use”  it  is  too  sharp  and  strong,  but  the  , 
Sanitary  Caustic  can  be  safely  applied  in  such  cases  by  any  reasonably 
careful  person,  and  has  been  found  effective  in  removing  nsevi  of  con¬ 
siderable  size.  See  page  1230.] 

Club=foot. — A  deformity  which  is  not  very  rare,  and  which  is 
usually  very  amenable  to  early  treatment,  is  “club-foot.”  This  consists 
of  a  malformation,  in  which  the  foot  is  twisted  in  some  peculiar  direc¬ 
tion,  so  that  the  sole  cannot  be  placed  properly  on  the  ground  when 
the  child  is  held  erect.  The  foot  may  be  twisted  upward  or  down¬ 
ward,  inward  or  outward,  and  there  may  be  a  combination  of  these 
directions  ;  the  more  common  instances  of  club-foot  being  those  in 
which  the  foot  is  twisted  downward  and  inward,  and  in  which  it  is 
displaced  upward  and  outward.  Club-foot  may  affect  only  one  foot, 
or  it  may  occur  in  both  feet.  It  is  caused  by  some  want  of  balance 
between  the  muscles  acting  on  the  different  parts  of  the  foot ;  and  it  is 


1 64  SOME  CONGENITAL  DEFECTS  IN  CHILDREN 

usually  rectified  by  restoring  tlie  balance  by  means  of  small  operations 
intended  to  lengthen  the  tendons  of  particular  muscles,  and  by  altering 
the  position  of  the  feet  with  the  aid  of  splints  or  bandages  of  plaster  of 
Paris.  It  is  of  much  importance  that  the  cure  should  be  carried  out 
early  in  life,  as,  if  operation  is  postponed  too  long,  the  bones  of  the 
foot  become  altered  in  shape  by  the  pressure  resulting  from  the  mis¬ 
placement,  and  the  result  of  operation  is  not  so  completely  satisfactory. 

Hare=lip. — The  presence  of  hare-lip  in  babies  calls  also  for  very 
early  operation,  if  the  result  is  to  be  thoroughly  satisfactory.  Hare-lip 
is  the  name  given  to  a  form  of  imperfect  development  affecting  the 
upper  lip,  which  is  completely  divided  near  the  centre  by  a  deep  fur¬ 
row,  reaching  from  the  pillar  of  the  nose  to  the  mouth.  Sometimes  the 
Fig.  24.  division  affects  also  the  upper  gum  and  the  roof  of 

(  $  k-.  \  the  moutlb  extending  back  to  the  uvula  ;  occasion¬ 

ally  there  is  a  double  division  of  the  lip,  with  a 
projection  of  skin  between  them,  attached  at  its 
base  to  the  nose.  Unpromising  as  such  cases  may 
at  first  sight  appear,  they  are  perfectly  amenable 
to  treatment  by  surgical  operation  ;  and  a  success¬ 
ful  operation  in  early  life  usually  results  in  the 
single  hare-lip.  restoration  of  the  proper  outline  of  the  lip,  leaving 
behind,  as  the  only  trace  of  the  deformity,  a  comparatively  inconspic¬ 
uous  cicatrix,  with  perhaps  a  very  slight  groove  in  the  edge  of  the  lip 
where  the  fissure  originally  commenced.  Where  the  hare-lip  has  been 
double  there  may  remain  two  parallel  cicatrices  in  place  of  one,  but 
this  does  not  add  to  the  conspicuousness  of  the  scar,  and  even  some¬ 
times  diminishes  it. 

Supernumerary  Fingers  and  Toes. — Babies  are  occasionally 
born  with  supernumerary  fingers  and  toes  ;  and  when  these  are  in  such 
a  position  as  to  be  inconvenient  when  the  child  grows  older,  or  to  look 
unsightly,  they  ought  to  be  removed  as  soon  after  birth  as  possible. 
Very  young  babies  bear  exceedingly  well  small  operations  in  which  no 
loss  of  blood  is  involved,  and  although  they  experience  pain  at  the 
time  of  the  operation,  certainly  are  not  so  sensible  of  any  subsequent 
discomfort  as  children  of  an  older  growth. 

Hernia,  or  rupture  of  a  part  of  the  bowel  through  some  weak 
point  in  the  abdominal  walls,  is  a  common  defect  in  young  infants. 
There  are  three  specially  weak  points  in  the  walls  of  the  abdomen 
where  ruptures  are  prone  to  occur. 

1.  The  situation  at  which  ruptures  most  frequently  are  observed 
in  infants  is  at  the  navel,  where  at  birth  the  umbilical  cord  is  attached. 
The  wall  of  the  abdomen  at  this  point  is  naturally  somewhat  weak  in 
infants,  and  any  exceptional  strain  upon  it,  such  as  may  result  from  its 
being  dragged  upon  by  the  cord  at  birth,  or  being  pressed  outward  by 


INFANTILE  HERNIA  OR  RUPTURE. 


165 

frequent  and  violent  crying,  is  apt  to  cause  a  small  piece  of  bowel  to 
project  in  such  a  way  as  to  form  a  small  tumor  under  the  skin.  That 
such  a  tumor  is  a  rupture  or  hernia  can  usually  be  demonstrated  by 
the  possibility  of  gently  pressing  it  backward  into  the  abdomen  so  as 
to  make  it  disappear,  and  by  its  return  when  the  pressure  is  removed, 
and  the  infant  begins  to  cry. 

Such  umbilical  herniae,  as  they  are  called,  are  generally  of  small 
size,  rarely  exceeding  the  dimensions  of  a  plum,  and  usually  only  at¬ 
taining  the  size  of  a  large  thimble.  With  reasonable  care  and  treat¬ 
ment,  they  are  invariably  cured.  All  that  is  required  for  the  cure  is 
that  an  elastic  belt  with  a  small  flat  pad  over  the  navel  should  be  ad- 
justed  to  the  infant,  and  maintained  in  its  position  for  six  months  or  a 
year,  only  being  removed  for  the  purpose  of  washing.  The  belt  should 
be  three  or  four  inches'  in  breadth,  and  is  best  made  with  silk  elastic 
attached  to  linen,  so  as  to  allow  of  adjusting  the  pressure  by  lacing  at 
the  back  ;  but  if  care  is  taken  to  prevent  any  irritation  of  the  skin,  a 
plain  india-rubber  band  may  be  used.  The  pressure  of  the  belt  should 
be  just  sufficient  to  keep  the  hernia  from  projecting  outward. 

2.  The  second  site  at  which  herniae  are  commonly  seen  is  just 
above  the  groin  on  either  side  of  the  body.  Herniae  occurring  at  this 
situation  are  called  inguinal  herniae,  and  are  met  with  almost  exclu¬ 
sively  in  male  infants  only.  They  vary  in  size  more  than  umbilical 
herniae,  but  do  not  project  so  much  even  when  large,  taking  a  course 
downward  under  the  skin  into  the  scrotum,  instead  of  pushing  their 
way  straight  outward.  They  are  recognized  by  the  same  characters 
as  the  umbilical  herniae,  being  returnable  into  the  abdomen  by  gentle 
pressure,  and  being  forced  out  again  by  crying  or  other  exertion  on  the 
part  of  the  infant. 

Considerable  care  and  attention  must  be  directed  to  their  cure.  It 
is  necessary  to  have  a  proper  truss  adjusted,  and  to  have  it  altered  from 
time  to  time  to  keep  pace  with  the  growth  of  the  child.  In  the  first 
six  months  of  the  infant’s  life  much  difficulty  is  usually  experienced  in 
preventing  the  truss  from  irritating  the  skin  upon  which  it  presses. 
Trusses  covered  entirely  with  india-rubber  are  usually  employed,  as 
they  do  not  suffer  injury  from  being  wetted  with  urine.  The  truss 
must  always  be  kept  as  clean  and  as  dry  as  possible,  and  the  skin  under¬ 
neath  where  the  truss  presses  must  be  washed,  dried  carefully,  and 
powdered  each  time  that  the  diapers  are  changed.  It  is  very  seldom 
that  an  inguinal  hernia  is  cured  in  less  than  a  year,  and  not  unfre- 
quently  two  or  three  years  must  be  allowed  to  elapse  before  the  truss 
can  be  safely  dispensed  with. 

3.  The  third  situation  where  hernise  are  occasionally  met  with  in 
infants  is  in  the  middle  line  of  the  abdomen,  at  any  point  between 
the  end  of  the  breastbone  and  tiie  navel.  Herniae  occurring  here  are 


1 66  SOME  CONGENITAL  DEFECTS  IN  CHILDREN. 

almost  invariably  very  small,  often  not  exceeding  the  size  of  a  pea. 
They  are,  however,  not  unfrequently  the  source  of  pain,  and  their  dim¬ 
inutive  size  occasionally  leads  to  their  being  overlooked,  more  especially 
as  in  well-nourished  children  they  can  sometimes  only  be  felt  and  not 
seen.  Their  character  is  demonstrated  by  their  disappearance  under 
pressure,  and  their  reappearance  afterward.  For  their  cure  a  belt 
similar  to  that  recommended  for  umbilical  hernia  must  be  employed, 
the  pad  being  placed  so  as  to  press  upon  the  site  of  the  rupture. 

Defects  of  the  Eye. — Children  are  occasionally  born  with  an  im¬ 
perforate  condition  of  the  small  canals  which  carry  off  the  secretion 
of  the  eyes  to  the  interior  of  the  nose.  Normally,  from  the  inner  cor¬ 
ners  of  the  lower  and  upper  eyelids  two  small  tubes  arise,  and  run  in¬ 
ward  to  a  small  bag  which  lies  between  the  inner  corner  of  the  eye  and 
the  nose,  from  which  a  somewhat  larger  tube  or  canal  leads  into  the 
back  of  the  nose.  The  commencement  of  the  small  tubes  can  be  seen 
distinctly  if  the  eyelids  are  slightly  everted.  The  secretion  from  the 
eye,  including  the  tears,  after  passing  over  the  eye,  flows  down  these 
small  tubes,  and  is  carried  through  the  bag  or  sac,  as  it  is  termed,  into 
the  nose.  If  these  tubes  are  imperforate,  the  secretion  escapes  at  the 
inner  corner  of  the  eye,  and  flows  down  the  cheek,  producing  in  time 
considerable  irritation.  When  this  first  occurs,  it  is  apt  to  be  mistaken 
for  slight  inflammation  of  the  eye,  and  the  mistake  is  a  natural  one,  as 
the  secretion,  if  it  does  not  find  its  proper  exit  through  the  tubes,  is 
apt  to  set  up  a  little  inflammation.  When,  however,  the  condition 
recurs  again  and  again,  suspicion  should  always  arise  as  to  the  possi¬ 
bility  of  want  of  patency  of  the  tubes,  and  the  attention  of  the  medical 
attendant  should  be  called  to  the  matter.  In  most  cases  only  a  very 
slight  operation  is  required  to  open  up  the  tubes  ;  but.  as  a  rule,  it  will 
have  to  be  done  under  an  anaesthetic  on  account  of  the  delicacy  of 
manipulation  required,  and  the  risk  of  damage  from  sudden  movement 
of  the  child. 

The  most  frequent  and  the  most  important  of  all  congenital  defects 
are  imperfections  of  Vision.  As  an  optical  instrument,  the  eye  is 
not  always  by  any  means  all  that  one  could  desire,  although  its  defici¬ 
encies  do  not  usually  become  apparent  until  a  few  years  have  elapsed 
from  birth.  Most  people  are  aware  that,  on  looking  through  a  tele¬ 
scope  or  field-glass,  some  adjustment  has  usually  to  be  made  to  bring 
objects  into  focus  before  the}7-  can  be  seen  clearly.  Now  the  most  fre¬ 
quent  congenital  defect  in  eyes  is  that  they  are  not  focussed  properly 
for  the  external  objects  at  which  they  are  intended  to  gaze.  A  certain 
power  of  altering  the  focus  is  possessed  by  all  eyes,  but  it  is  limited, 
while  the  divergences  in  structure  much  exceed  the  bounds  of  these 
limits.  It  results  that  some  eyes  can  only  see  clearly  objects  very  near 
to  them,  when  they  are  called  short-sighted,  or  myopic  ;  or  can  only  see 


CONGENITAL  FAULTS  OF  VISION. 


167 

distinctly  objects  at  a  distance,  when  they  are  named  long-sighted  or 
hypermetropic.  Some  eyes  are  so  very  inconveniently  formed  that 
they  are  long-sighted  for  perpendicular  objects,  and  short-sighted  for 
horizontal  objects,  or  the  reverse,  so  that  a  person  •with  such  eyes 
might  read  distinctly  a  clock  face  at  a  distance  when  the  hour  was 
half-past  twelve,  but  could  not  see  the  hands  at  all  when  they  were 
placed  at  fifteen  minutes  to  three.  Such  eyes  are  called  astigmatic. 

Of  the  three  forms  of  abnormality  of  sight,  the  one  usually  dis¬ 
covered  earliest  is  Iong=*ight  or  hypermetropia,  and  for  the  reason 
that  it  very  frequently  gives  rise  to  the  unsightly  affection  known  a? 
“squint.” 

Squinting  in  children  is  almost  invariably  the  result  of  some  im¬ 
perfection  of  sight,  and  in  tbe  great  majority  of  cases  the  imperfection 
is  hypermetropia.  The  reason  of  this  cannot  be  fully  explained  here, 
but  it  may  be  said  in  general  terms  that  it  results  from  the  effort  made 
by  a  long-sighted  child  to  get  clear  vision  of  objects  in  close  proximity 
to  him.  The  squint  is  thus  most  likely  to  occur  at  an  age  when  the 
child  begins  to  make  use  of  playthings  requiring  accurate  vision,  such 
as  puzzles,  pictures,  etc.  When  any  abnormal  position  of  one  eye  with 
relation  to  the  other  is  noticed  on  a  child  concentrating  its  attention 
upon  any  object,  it  is  time  to  take  medical  advice  respecting  the  con¬ 
dition  of  the  accommodation  of  the  eyes.  If  neglected,  the  squint  may 
in  time  become  permanent,  and  not  only  is  the  result  unsightly,  but 
often  the  sight  is  still  further  impaired.  At  the. same  time,  it  is  never 
too  late  to  take  advice  regarding  the  visual  powers ;  and  squints  of 
considerable  duration  can  frequently  be  cured  by  the  employment  of 
properly  selected  spectacles.  As  a  rule,  children  do  not  at  all  dislike 
wearing  glasses,  and  even  when  only  three  or  four  years  old  will  take 
good  care  of  them  and  keep  them  from  injury. 

Short=sight  or  myopia  does  not  usually  make  itself  apparent  so 
early  as  hypermetropia,  as  it  is  much  less  frequently  the  cause  of  squint. 
It  is  most  commonly  first  detected  when  the  child  goes  to  school,  it 
being  remarked  that  it  cannot  see  clearly  figures  drawn  on  a  black 
board,  or  letters  of  large  type  at  a  distance.  Children  suffering  from 
short-sightedness  are  not  unfrequently  punished  for  errors  which  seem 
faults  due  to  inattention  and  stupidity,  but  which  are  really  attribu¬ 
table  to  the  imperfection  of  their  sight.  When  a  child  complains  that 
it  cannot  read  or  see  distinctly  what  is  quite  apparent  to  other  children 
at  the  same  distance,  the  possibility  of  the  existence  of  short  sighted¬ 
ness  should  always  present  itself  to  the  teacher  or  mother.  The  exist¬ 
ence  of  astigmatism  is  usually  discovered  in  the  examination  of  the 
eyes  when  short-sightedness  or  long-sightedness  has  been  suspected, 
one  or  other  of  these  usually  predominating  in  an  astigmatic  eye,  and 
calling  for  correction  before  the  astigmatism  is  dealt  with. 


CHAPTER  XVI 


Hints  on  Nursing  Children  during  Illness. 

Duties  of  a  Nurse;  Observation  of  the  Patient;  Respiration;  Pulse;  Tempera¬ 
ture;  The  Clinical  Thermometer;  Hygiene  of  Sick-room;  Cleanliness;  Ven¬ 
tilation,  Temperature;  Light  and  Sunshine;  Hygiene  of  Invalid:  Cleanli¬ 
ness;  Clothing;  Food;  Administration  and  Application  of  Remedial 
Agents;  Mixtures;  Powders;  External  Applications ;  Warm  Fomentations; 
Spongio-piline;  Poultices:  Linseed  Poultice,  Bread  Poultice,  Starch  Poul¬ 
tice;  Application  of  Dry  Heat,  of  Cold;  Compresses;  Counter-irritation; 
Stimulating  Liniments;  Mustard  Plasters;  Poultices;  Turpentine  Stoups; 
Medicated  Applications;  Sedative  Liniments;  Ointments;  Lotions;  Syring- 
ingofEars;  Applications  to  Throat;  Leeches  ;  Management  of  Infectious 
Diseases;  Disinfectants;  Their  Abuse. 

Duties  of  a  Nurse  during  Illness.— The  duties  which  a  nurse 
may  be  called  upon  to  perforin  during  illness  may  be  most  conveniently 
described  under  three  heads  :  the  observation  of  the  patient,  the  main¬ 
tenance  of  the  patient  and  the  sick-room  in  thorough  sanitary  order, 
and  the  administration  and  application  of  remedial  agents. 

I.  Observation  of  the  Patient. — This  duty,  one  of  the  most 
interesting  to  a  careful  and  enthusiastic  nurse,  is  also,  in  the  case  of 
illness  in  children  so  young  as  to  be  unable  to  describe  their  sensations 
and  to  indicate  sources  of  discomfort  and  pain,  one  of  great  importance. 
The  medical  attendant  only  sees  his  patient  for  a  short  time  daily,  and 
must  depend  upon  the  intelligence  and  watchfulness  of  the  nurse  for  an 
accurate  account  of  any  symptoms  which  may  have  presented  them¬ 
selves  in  the  intervals  between  his  visits.  Nurses  desirous  of  satisfac¬ 
torily  fulfilling  their  duties  should  train  themselves  to  note  carefully, 
and  to  report  conscientiously,  anything  with  reference  to  the  patient 
which  may  throw  light  on  the  character  or  progress  of  the  illness.  It 
is  not  for  the  nurse  to  judge  of  the  value  of  any  symptom  which  may 
present  itself  ;  its  existence  should  merely  be  remarked,  and  related  to 
the  medical  attendant  on  the  first  opportunity. 

An  enumeration  of  the  principal  facts  upon  which  the  nurse  is  ex¬ 
pected  to  afford  information  to  the  doctor  in  attendance  will  include, 
in  the  first  place,  an  intelligent  description  of  the  general  demeanor 
of  the  patient,  whether  restless,  irritable,  quiet,  somnolent,  or  cheer¬ 
ful.  It  will  also  include  an  account  of  the  appetite  of  the  invalid, 

168 


THE  DOCTOR’S  RAY  OF  HOPE. 


THE  STUDY  OF  SYMPTOMS. 


169 


of  the  quantity  of  food  taken,  and  of  the  amount  of  sleep  obtained 
during  the  night.  The  nurse  will  also  be  relied  upon  to  mention 
any  alterations  which  may  have  occurred  in  the  appearance  of  the 
invalid,  the  presence  of  any  pallor  or  flushing  of  the  face,  of  any  sick- 
nessj  of  delirium,  of  twitching  of  the  muscles,  or  generally  of  any 
phenomena  indicative  of  a  departure  from  health.  When  cough  is 
present,  she  should  be  able  to  describe  in  general  terms  its  frequency 
and  character  ;  and  if  expectoration  exists,  to  indicate  its  appearance 
and  amount.  She  should  also  be  in  a  position  to  state  the  frequency 
with  which  the  bowels  and  kidneys  have  acted,  and  to  give  a  descrip¬ 
tion  of  the  character  of  their  excretions.  In  her  daily  ablution  of  the 
invalid  she  is  afforded  an  opportunity  of  observing  any  unusual  appear¬ 
ance  of  the  skin  ;  and  the  existence  of  any  eruption  or  rash,  however 
slight,  should  always  be  remarked,  as  its  presence  may  be  of  much 
significance.  There  are  three  special  symptoms  which  nurses  are  ex¬ 
pected  to  observe  and  report  upon,  and  about  which  it  is  desirable  they 
should  possess  some  information. 

1.  The  first  of  these  is  the  frequency  of  respiration  or  breath= 

ing.  In  many  diseases  of  the  heart  and  lungs  the  frequency  of  breath¬ 
ing  throws  much  light  on  the  severity  and  progress  of  the  illness,  and 
an  exact  record  taken  at  different  periods  of  the  day  is  of  much  value 
to  the  medical  attendant.  It  is  customary  to  describe  the  frequency  by 
counting  the  number  of  respirations  or  acts  of  breathing  occurring  in 
one  minute,  the  enumeration  being  effected  with  the  aid  of  a  watch 
provided  with  a  seconds’  hand.  In  general,  there  is  no  difficulty  in 
distinguishing  each  act  of  respiration  by  watching  the  movement  of  the 
chest,  which  rises  and  expands  during  inspiration,  and  falls  and  con¬ 
tracts  during  expiration.  When  the  breathing  is  so  shallow  as  to  render 
the  movement  inconspicuous,  it  may  be  felt  by  placing  the  hand  gently 
on  the  front  of  the  chest.  Not  unfrequently  the  successive  acts  of  in¬ 
spiration  are  quite  audible,  and  can  be  counted  by  attentive  listening. 
Sometimes,  more  especially  when  breathing  is  difficult,  each  inspiratory 
act  is  accompanied  by  dilatation  of  the  nostrils,  by  watching  which  the 
rapidity  of  breathing  can  be  estimated. 

The  normal  frequency  of  respiration  in  a  healthy  child  varies 
from  twenty  to  twenty -five  breaths  per  minute ;  in  disease  it  may 
increase  beyond  eighty  per  minute,  or  fall  below  fifteen.  When  the 
nurse  has  enumerated  the  acts  of  breathing  in  one  minute,  she  should 
make  a  written  note  of  the  number,  and  the  hour  at  which  the  observa¬ 
tion  was  made,  and  should  at  the  same  time  remark  any  peculiarity 
connected  with  the  respiration,  such  as  irregularity  in  rhythm,  or  the 
presence  of  wheezing,  snoring,  or  hissing  sounds. 

2.  The  second  special  symptom  which  the  nurse  is  expected  to 

record  is  the  frequency  of  the  pulse. 

Ca 


l7o  HINTS  ON  NURSING  CHILDREN  DURING  ILLNESS. 

The  pulse,  which  beats  synchronously  with  the  heart,  and  indicates 
the  frequency  and  to  some  extent  the  strength  of  its  action,  is  usually 
felt  about  an  inch  above  the  base  of  the  thumb,  on  the  outer  side  of 
the  wrist,  where  an  artery  of  medium  size  passes  over  one  of  the  bones 
of  the  fore-arm.  This  artery  is  selected  chiefly  on  account  of  its  super¬ 
ficial  position  and  its  relation  to  the  bone  behind  it,  which  forms  a 
resisting  surface  against  which  the  artery  can  be  pressed  by  the  fingers. 
Every  artery  in  the  body  pulsates  in  a  similar  manner,  and  when  from 
some  abnormality  of  position  of  the  radial  artery,  as  it  is  named,  the 
pulse  cannot  be  felt  in  the  usual  position,  an  artery  on  the  inner  side  of 
the  wrist  may  be  utilized,  or  the  pulsations  of  the  heart  itself  against  the 
wall  of  the  chest  may  be  counted.  In  counting  the  pulse  in  the  usual 
position,  one  or  two  fingers  are  laid  upon  the  artery,  which  they  press 
gently  against  the  bone  behind.  The  pulsations  are  usually  easily 
recognized  as  successive  gentle  beats  against  the  fingers,  and  are  count¬ 
ed  with  the  aid  of  the  seconds’  hand  of  a  watch.  A  convenient  method 
is  to  count  the  number  of  beats  in  four  successive  quarters  of  a  minute, 
and  to  add  the  four  numbers  together  to  arrive  at  the  number  of  beats 
per  minute,  which  is  recorded  as  the  pulse-rate.  By  taking  the  pulse  in 
this  way,  its  regularity  or  irregularity  is  ascertained,  as  well  as  its 
frequency. 

The  Normal  Pulse  in  Children  varies  from  about  120  beats  per 
minute  in  infancy  to  about  90  after  the  age  of  two  years.  Very  slight 
disturbances  are  apt  to  increase  the  frequency  considerably,  and  with 
only  moderate  fever  a  rapidity  of  150  or  160  beats  per  minute  may  be 
attained.  On  account  of  the  extreme  susceptibility  of  the  action  of  the 
heart  to  comparatively  small  influences,  the  information  given  by  in¬ 
creased  rapidity  of  the  pulse  in  disease  in  children  is  not  by  any  means 
so  valuable  as  that  afforded  in  the  case  of  adults  ;  its  importance,  how¬ 
ever,  increases  with  the  age  of  the  child,  while  abnormal  slowness  is 
always  a  symptom  of  much  value,  and  generally  one  of  serious  import. 

3.  The  third  special  symptom  to  be  recorded  by  the  nurse  is  the 
temperature  of  the  patient,  a  symptom  of  much  significance  and 
value  to  the  medical  attendant.  To  ascertain  the  temperature  of  an 
invalid,  the  nurse  makes  use  of  a  thermometer  of  peculiar  construction, 
called  a  clinical  thermometer.  This  instrument  differs  from  an  ordinary 
thermometer  chiefly  in  the  fact  that  the  thin  column  of  mercury  con¬ 
tained  in  it  does  not  fall  when  exposed  to  cold,  although  it  rises  when 
exposed  to  heat,  the  height  of  the  column  of  mercury  at  any  time  thus 
indicating  the  highest  degree  of  heat  to  which  the  thermometer  has 
been  exposed.  Another  point  of  difference  is  that  although  the  mer¬ 
cury  does  not  fall  when  exposed  to  cold,  it  can  be  shaken  or  knocked 
gently  downward  until  the  column  recedes  almost  entirely  into  the 
bulb  of  the  thermometer.  A  third  distinctive  point  is  that  the  range 


NORMAL  HUMAN  TEMPERATURE. 


171 


of  the  scale  is  much  more  limited  than  in  an  ordinary  thermometer, 
generally  extending  from  about  95°  F.  at  the  lower  end  to  110°  F.  or 
112°  F.  at  the  higher  end.  The  reason  for  this  limitation  is  that  this 
range  represents  practically  the  extreme  variations  of  the  temperature 
of  the  human  body  in  disease. 

The  Normal  Temperature  of  the  Human  Body  in  Health  is 

remarkably  constant  at  all  ages  and  under  all  circumstances,  seldom 
varying  more  than  three  or  four  tenths  of  a  degree  above  or  below 
98.4°  F.,  which  is  generally  marked  on  clinical  thermometers  as  the 
normal  point.  Some  slight  difference  is  noticed  according  to  the  posi¬ 
tion  in  wrhich  the  thermometer  is  placed  when  the  temperature  is  taken. 
Most  commonly  the  bulb  of  the  thermometer  is  placed  within  the  arm- 
pit,  while  the  arm  is  pressed  closely  against  the  side  ;  but  in  certain 
circumstances  a  more  accurate  record  is  obtained  by  placing  the  bulb 
of  the  instrument  under  the  tongue,  while  the  stem  is  held  between  the 
lips.  In  the  latter  position  the  thermometer  usually  registers  a  tempera¬ 
ture  one  or  two  tenths  of  a  degree  higher  than  when  placed  in  the  arm- 
pit.  In  the  scale  of  a  clinical  thermometer  each  degree  is  usually 


CLINICAL  THERMOMETER. 


divided  by  four  small  lines,  the  space  .between  each  of  which  represents 
one  fifth  of  a  degree  ;  the  half  of  such  space  thus  represents  one  tenth 
of  a  degree,  which  is  represented  in  writing  by  a  decimal  figure. 
Before  taking  the  temperature  of  a  patient,  the  nurse  must  “set”  the 
thermometer  by  shaking  down  the  column  of  mercury  until  it  falls  one 
or  two  degrees  below  the  normal  point  of  98.4°  F.  This  is  most  easily 
managed  by  giving  the  instrument  a  few  sharp  jerks,  or  by  holding  it 
in  one  hand,  with  the  bulb  downward,  and  striking  that  hand  gently 
against  the  other,  taking  care  to  avoid  injury  to  the  thermometer. 
When  properly  set,  it  is  placed  either  in  the  armpit  or  under  the  tongue 
of  the  patient,  and  left  there  for  four  or  five  minutes,  the  time  re¬ 
quired  varying  with  the  sensitiveness  of  the  thermometer.  It  is  then 
removed,  and  the  height  to  which  the  column  of  mercury  has  risen  is 
read  off  in  degrees  and  tenths  of  degrees,  and  noted  in  decimal  notation. 
For  example,  if  the  mercury  has  risen  to  exactly  the  middle  point  be¬ 
tween  100°  F.  and  101°  F.,  its  height  is  recorded  in  100.5°  F. ;  if  it  has 
risen  to  four-fifths  of  a  degree  above  100°  F.,  it  is  registered  in  100.8° 
F.  It  is  desirable  to  note  in  writing  at  once  both  the  height  of  the 
temperature,  and  the  hour  at  which  it  has  been  taken. 

When  any  variation  from  the  normal  heat  of  the  body  occurs  dur¬ 
ing  illness,  it  is  almost  invariably  an  increase  of  temperature  which  is 


1 72 


HINTS  ON  NURSING  CHILDREN  DURING  ILLNESS. 


observed.  Feverishness,  which  is  a  very  common  characteristic  of 
many  disorders,  involves  increase  of  temperature,  varying  in  different 
cases  from  one  or  two,  to  seven  or  eight  degrees.  Under  ordinary  cir¬ 
cumstances  of  illness  accompanied  by  fever,  it  is  seldom  that  a  tem¬ 
perature  higher  than  104°  F.,  or  105°  F.  is  observed  ;  but  in  severe 
cases  the  temperature  of  the  invalid  may  rise  to  107°  F.  or  108°  F.,  or 
even  further.  Any  temperature  exceeding  105°  F.  is  generally  indica¬ 
tive  of  considerable  severity  of  disease.  Reduction  of  temperature 
below  the  normal  point  occurs  sometimes  to  a  slight  extent  in  illnesses 
where  much  weakness  exists,  and  in  convalescence  from  acute  diseases  ; 
the  reduction  seldom  exceeds  one  or  two  degrees,  and  does  not  as  a 
rule  give  rise  to  anxiety. 

II.  Hygiene  of  the  Sick=room  and  Patient. — The  second  de¬ 
partment  of  the  duties  of  a  nurse  is  the  maintenance  of  the  sick-room 
and  patient  in  perfect  sanitary  order.  The  sanitary  requirements  of  a 
sick-room  are  cleanliness,  pure  air,  regulated  temperature,  and  light, 
including  as  much  sunlight  as  possible  ;  of  an  invalid,  cleanliness, 
suitable  clothing,  and  appropriate  food.  Some  suggestions  remain  to 
be  made  under  each  of  these  heads. 

Cleanliness  of  the  Sick=room. — The  maintenance  of  cleanliness 
is  one  of  the  most  important  duties  of  a  nurse  ;  it  has  been  said,  indeed, 
by  Florence  Nightingale,  the  originator  of  scientific  nursing,  that  “the 
fear  of  dirt  is  the  beginning  of  good  nursing.”  Not  only  must  the  bed 
and  bedding  upon  which  the  child  lies  be  kept  scrupulously  clean,  but 
every  part  of  the  room  and  its  contents  should  be  carefully  supervised, 
and  all  dust  and  dirt  removed.  When  possible,  carpets  and  stuff  cur¬ 
tains  should  be  taken  out  of  the  room  in  which  an  invalid  is  residing  ; 
if  desired  for  the  sake  of  appearance,  one  or  two  rugs,  which  can  be  re¬ 
moved  from  the  room  and  shaken  well  every  day,  may  be  substituted 
for  the  carpets,  while  light  'washing  curtains  may  replace  the  stuff 
ones.  All  unnecessary  furniture  should  be  dispensed  with,  not  only 
because  it  affords  a  refuge  for  dirt,  but  also  because  it  occupies  space 
which  may  be  more  satisfactorily  filled  with  fresh  air.  The  floor  of 
a  sick-room  should  not  be  swept,  but  should  be  rubbed  over  carefully 
with  a  wet;  cloth,  and  furniture  should  be  kept  clean  in  the  same  way. 
The  ordinary  process  of  what  is  called  “dusting”  generally  consists  of 
removing  dust  from  a  conspicuous  place  where  it  can  be  seen,  to  an 
inconspicuous  place  where  it  is  out  of  sight,  but  equally  capable  of 
doing  harm,  and  is  quite  inappropriate  to  the  sanitary  wants  of  a  sick- 
chamber.  No  dishes  with  foods  or  drinks  should  be  allowed  to  remain 
in  the  room  longer  than  they  are  required  for  use  :  they  should  always 
be  removed  and  cleaned  immediately.  This  remark  applies  even  more 
strongly  to  sanitary  utensils,  such  as  bed-pans,  and  urinary  recepta¬ 
cles  ;  these  should  always  be  removed  from  the  room,  with  a  cover 


VENTILATION  OF  THE  SICK  ROOM. 


173 

over  them,  immediately  after  they  are  used,  and  not  brought  back  until 
again  wanted. 

It  is  most  important  in  the  interests  of  the  invalid  that  the  bed  and 
bedding  should  be  maintained  in  as  clean  and  well-aired  condition 
as  possible.  From  the  human  skin,  both  in  health  and  in  illness, 
vapor  is  constantly  excreted,  containing  impure  emanations,  which  are 
absorbed  by  the  clothing  and  by  the  coverings  of  the  bed.  It  is  neces 
sary  that  these  should  be  removed  from  the  bedding  by  frequent  airing, 
otherwise  they  accumulate  to  such  an  extent  as  to  be  positively  injuri¬ 
ous  to  the  invalid.  In  severe  illnesses  of  some  duration  the  most  con¬ 
venient  method  of  maintaining  purity  of  the  bedding  is  to  have  two 
separate  beds — one  for  day  use  and  the  other  for  night  use  ;  and  to  air 
the  bed-clothes  thoroughly  every  day,  by  exposing  them  for  some  hours 
either  to  the  rays  of  the  sun  in  a  thoroughly  ventilated  room,  or  before 
the  flame  of  an  open  fire.  When  this  arrangement  is  impracticable,  a 
double  set  of  sheets  should  be  used,  and  changed  morning  and  evening, 
being  thoroughly  aired  before  being  replaced  on  the  bed. 

Ventilation  of  the  Sick=room. — The  air  in  every  inhabited  room 
js  constantly  undergoing  contamination  from  the  various  impurities 
excreted  from  the  lungs  and  skin  of  the  persons  living  in  it  ;  and  in 
order  that  the  atmosphere  of  the  room  may  not  become  injurious  to  the 
inhabitants,  it  is  necessary  that  some  arrangement  should  exist  for  the 
continuous  removal  of  the  impure  air,  and  for  its  replacement  by  a 
fresh  and  pure  supply.  The  substitution  of  the  pure  for  the  impure 
air  takes  place  in  two  different  ways.  In  the  first  place,  air,  like  other 
gases,  possesses  the  property  of  “diffusion,”  by  which  is  meant  that 
when  two  gases  of  any  kind,  such  for  instance  as  oxygen  and  nitrogen, 
or  pure  and  impure  air,  come  in  contact  intimately,  they  intermingle 
closely  with  each  other,  instead  of  remaining  separate  as  two  fluids,  oil 
and  water  for  example,  would.  The  interstices  of  the  windows  and 
doors  of  a  room,  the  open  chimney,  and  the  door  afford  facilities  for 
this  intermingling,  and  contribute  considerably  to  satisfactory  ventila¬ 
tion.  But  the  more  important  factor  in  ventilation  is  the  quality  which 
air  possesses,  in  common  with  other  gases  and  fluids,  of  becoming 
heavier. when  its  temperature  is  reduced,  and  lighter  when  its  tempera¬ 
ture  is  raised.  The  heavier  air  tends  naturally  to  fall  and  to  displace 
upward  the  lighter  air,  which  is  pushed  out  at  any  convenient  outlet 
by  the  cool  air  entering  at  any  available  inlet.  Most  of  the  agencies 
which  tend  to  render  the  atmosphere  of  a  room  impure  tend  also  to 
raise  its  temperature,  so  that  the  temperature  of  a  room  requiring  fresh 
air  is  usually  higher  than  that  of  the  external  fresh  air  surrounding  it. 
The  heavier  external  air  is  thus  constantly  attacking  and  invading  the 
lighter  internal  air,  and  driving  it  outward  laden  with  its  required  im¬ 
purities. 


I74  HINTS  ON  NURSING  CHILDREN  DURING  ILLNESS. 

In  any  room  unprovided  with  special  arrangements  for  ventilation, 
the  fresh  and  pure  air  enters  by  the  interstices  of  the  window,  and 
generally  of  the  door  also,  while  the  warm  and  impure  air  finds  its  exit 
usually  by  the  chimney.  If  no  chimney  exists,  the  fresh  air  entering 
by  the  interstices  of  the  window  will  expel  the  contaminated  air  through 
those  of  the  door  ;  but  the  interchange  of  air  will  be  much  slowrer  than 
when  a  chimney  exists.  The  importance  of  the  chimney  of  a  room  as 
an  aid  to  ventilation  is  not  unfrequeutly  overlooked  ;  and  indeed,  from 
ignorance,  the  chimney  is  sometimes  rendered  useless  by  the  closure  of 
the  flue,  when  no  fire  is  required.  Unless  other  means  of  ventilation 
have  been  specially  arranged,  chimneys  ought  always  to  be  left  open, 
and  to  be  kept  clean.  When  a  fire  is  burning  in  the  grate,  the  value  of 
the  chimney  as  an  exhauster  of  impure  air  is  much  enhanced,  the 
greatly  increased  temperature  of  the  air  in  the  chimney  resulting  from 
the  fire  beneath  giving  rise  to  a  continuous  upward  current,  which  aids 
most  effectively  in  ventilating  the  room. 

The  risks  to  be  avoided  or  overcome  in  ventilating  a  room,  when 
Jhe  external  temperature  is  considerably  lower  than  that  of  the  interior, 
are  the  undue  lowering  of  the  temperature  of  the  room,  and  the  occur¬ 
rence  of  “draughts”  or  currents  of  cold  air.  These  must  be  obviated 
by  admitting  the  fresh  and  colder  air  in  such  manner  as  to  intermingle 
thoroughly  with  the  warmer  air  within,  and  in  such  quantity  as  not  to 
unduly  depress  the  temperature.  Generally  speaking,  the  opening  of 
the  upper  part  of  the  window  to  a  small  extent  affords  the  most  con¬ 
venient  ingress  for  fresh  air,  as  it  then  comes  immediately  in  contact 
with  the  warmed  air  near  the  ceiling  of  the  room,  and  is  raised  in  tem¬ 
perature  while  falling  downward  through  it.  Another  convenient 
entrance  for  pure  air  can  without  much  difficulty  be  arranged  in  the 
middle  of  the  window  by  raising  the  lower  sash  one  or  two  inches,  and 
filling  up  the  space  left  below  by  a  board  of  wood  fitted  for  the  purpose. 
A  space  is  thus  formed  between  the  upper  and  lower  sashes  communi¬ 
cating  with  the  external  air,  which  on  entering  is  directed  upward  to 
the  ceiling,  and  thus  becomes  warmed. 

When  the  external  temperature  is  too  low  to  admit  of  any  part  of 
the  window  being  continuously  open,  the  atmosphere  of  the  room  can 
be  sufficiently  freshened  by  opening  the  window  widely  for  two  or 
three  minutes  occasionally,  at  the  same  time  covering  the  child's  head 
as  well  as  its  body  thoroughly  with  the  bed-clothes.  This  should  not 
be  done,  however,  in  cases  where  great  uniformity  of  temperature  is 
essential  to  the  treatment. 

In  such  cases,  and  in  others  where  ventilation  by  open  windows  is 
undesirable,  the  door  of  the  room  may  be  utilized  to  admit  air  which 
lias  already  been  partially  warmed  in  its  transit  through  the  house. 
When  a  door  is  left  partially  open  to  admit  fresh  air,  it  should  always 


TEMPERATURE  OF  THE  SICK-ROOM. 


175 


be  fixed  in  position  by  a  small  wedge,  or  by  a  weight  placed  od  either 
side,  as  any  noise  occasioned  by  its  accidental  movement  is  irritating  to 
an  invalid. 

When  fresh  air  is  introduced  by  any  of  the  methods  mentioned 
into  a  room  of  fair  size,  no  “draughts,”  as  a  rule,  will  be  perceived. 
If,  on  account  of  the  shape  of  the  room,  or  from  other  causes,  cold 
currents  of  air  are  found  to  be  present,  the  bed  of  the  patient  must  be 
placed  in  such  a  position  as  not  to  be  affected  by  them  ;  or  their  course 
must  be  diverted  by  the  employment  of  movable  screens.  The  necessity 
of  efficient  ventilation  should  always  be  kept  in  view  by  a  nurse ;  in 
all  cases  of  illness  it  is  of  much  value,  in  many  cases  it  is  of  abso¬ 
lutely  vital  importance  to  the  welfare  of  the  invalid. 

Temperature  of  the  Sick-room. — The  maintenance  of  a  fairly 

uniform  temperature  in  the  sick-room  is  called  for  in  most  diseases  of 
any  severity,  and  in  a  climate  so  variable  as  that  of  England  claims 
considerable  attention  from  the  nurse.  It  is  very  seldom  that  the  ex¬ 
ternal  temperature,  even  during  the  day,  remains  as  constant  as  is  de¬ 
sirable  in  many  cases  of  serious  illness,  while  the  very  great  difference 
between  the  temperature  of  midday  and  midnight,  at  almost  all  seasons 
of  the  37ear,  renders  it  absolutely  necessary  to  resort  to  means  and 
appliances  for  artificially  modifying  the  degree  of  warmth  of  the  in¬ 
valid’s  chamber.  For  the  purpose  of  satisfactorily  regulating  the  tem¬ 
perature,  a  thermometer  should  be  placed  in  some  part  of  the  room  in 
such  a  position  that  it  is  not  subjected  to  the  direct  rays  of  the  sun  or 
of  an  open  fire. 

The  temperature  at  which  a  sick-room  should  be  maintained  will 
vary  somewhat  with  the  character  of  the  illness,  and  with  the  wishes 
of  the  medical  attendant.  Generally  speaking,  it  should  not  be  allowed 
to  fall  beiow  60°  F.  or  to  rise  above  65°  F.  In  some  cases  of  illness, 
more  especially  when  the  lungs  are  affected,  a  constant  temperature  of 
70°  F.  may  be  demanded  ;  and  even  a  higher  temperature  than  this 
may  be  exceptionally  useful,  in  diseases  where  artificial  moisture  as 
well  as  elevated  temperature  is  called  for. 

When  attainable,  the  rays  of  the  sun  should  always  be  utilized  for 
raising  the  temperature  of  an  invalid’s  room,  in  preference  to  any  arti¬ 
ficial  source  of  heat.  These  rays  not  only  warm  the  atmosphere,  but 
also  purify  the  air,  while  in  addition  they  undoubtedly  exercise  a  bene¬ 
ficial  influence  on  the  progress  of  many  diseases. 

When  the  rays  of  the  sun  are  not  available,  recourse  must  be  had 
to  artificial  sources  of  heat,  and  of  these,  open  coal  fires  are  to  be  pre¬ 
ferred  to  any  other  methods  of  raising  the  temperature  of  a  room.  The 
one  drawback  to  their  employment  is  the  occasional  disturbance  to  the 
patient  involved  in  the  addition  of  fresh  coals,  and  in  the  use  of  the 
poker.  The  former  difflculiy  i*,  however,  easily  overcome  by  wrapping 


1 76  HINTS  ON  NURSING  CHILDREN  DURING  ILLNESS. 

up  previously  small  quantities  of  coal  in  paper  parcels,  each  sufficient 
for  one  addition  to  the  fire,  and  placing  the  parcels  quietly,  as  required, 
on  the  top  of  the  burning  coals.  If  this  is  done  judiciously,  and  a  good 
burning  coal  be  selected,  the  use  of  the  poker  may  generally  be  dis¬ 
pensed  with  altogether. 

When  gas  fires  are  employed  in  a  bedroom,  great  care  must  be 
taken  that  the  ventilation  is  satisfactory,  and  that  the  up-drauglit  of  the 
chimney  is  sufficient  to  carry  away  all  the  noxious  fumes  resulting  from 
the  combustion  of  gas.  Unlike  the  smoke  of  coal,  the  products  of 
combustion  of  gas  are  invisible,  but  are  none  the  less  injurious.  Fortu¬ 
nately,  however,  their  presence  in  the  atmosphere  in  any  appreciable 
quantity  can  usually  be  detected  by  the  sense  of  smell.  Gas  fires  dry 
the  atmosphere  much  more  than  coal  fires,  and  for  this  reason  are 
ineligible  in  cases  of  disease  of  the  throat  and  lungs,  in  which  generally 
a  very  moist  atmosphere  is  desirable.  To  some  extent  this  defect  may 
be  remedied  by  the  use  of  water-evaporating  dishes  in  the  proximity  of 
the  gas  fire,  but  it  is  seldom  that  even  by  their  aid  a  perfectly  satisfac¬ 
tory  condition  of  the  atmosphere  is  attained. 

It  is  seldom  that  any  measures  have  to  be  taken  in  England  to  re¬ 
duce  the  temperature  of  an  invalid’s  room,  there  being  usually  no  risk 
or  discomfort  involved  to  the  invalid  in  a  rise  of  temperature  of  several 
degrees  beyond  what  is  considered  desirable  for  the  particular  disease, 
such  as  would  result  from  a  fall  to  the  same  extent.  When  it  is  con¬ 
sidered  necessary  to  cool  the  atmosphere  of  the  room,  the  exclusion  of 
the  rays  of  the  sun  by  dark  blinds,  and  the  free  opening  of  windows 
and  doors,  will  generally  effect  the  end  in  view. 

Light  and  Sunshine  in  the  Sick=room. — The  value  of  light  and 
sunshine  in  the  treatment  of  disease  has  been  much  insisted  on  of  late 
years.  Irrespective  of  the  close  relationship  between  light  and  cleanli¬ 
ness,  evidence  has  shown  conclusively  the  near  connection  between 
light  and  vitality  ;  the  processes  of  nutrition  and  assimilation  are  found 
to  progress  more  satisfactorily,  and  the  power  of  resistance  to  noxious 
influences  to  increase,  in  proportion  to  the  abundance  of  light.  In 
cases  of  illness  wdiere  there  exists  intolerance  of  light,  a  screen  should 
be  arranged  if  possible  to  protect  the  eyes  of  the  invalid  while  the  light 
is  admitted  to  the  rest  of  the  room,  or  curtains  may  be  hung  tempora¬ 
rily  on  one  side  of  the  bed  ;  but  the  whole  room  should  not  be  dark¬ 
ened  unless  by  the  doctor’s  orders,  given  for  the  purpose  of  utilizing 
the  darkness  in  the  treatment  of  some  particular  disease.  Apparently 
the  beneficial  influence  of  light  belongs  only  to  the  natural  light  pro¬ 
ceeding  directly  or  indirectly  from  the  rays  of  the  sun,  so  that  the 
propriety  of  artificial  light  at  night  must  be  decided  on  other  grounds, 
it  being  kept  in  view  that  all  artificial  lights,  except  electric  lamps, 
are  potent  agents  in  the  contamination  of  the  atmosphere  of  the  room 


BATHING  AND  CLOTHING  INVALIDS. 


177 


Cleanliness  of*  the  Invalid. — In  all  cases  of  illness,  where  no 
special  reason  exists  to  the  contrary,  invalids  should  be  washed  com¬ 
pletely  twice  a  day,  morning  and  evening.  In  doing  this,  care  must  be 
taken  that  the  patient  is  not  unduly  exposed  to  cold.  Each  part  of 
the  body  should  be  attended  to  successively,  carefully  washed  with 
soap  and  warm  water,  and  then  dried  before  the  succeeding  part  is 
commenced.  Much  care  should  be  taken  that  the  drying  is  thorough  ; 

I  he  towels  used  for  this  purpose  should  be  perfectly  dry  and  slightly 
warmed.  When  any  irritation  of  the  skin  exists,  some  dry  absorbent 
powder,  such  as  powdered  starch,  should  be  dusted  on  after  the  drying 
is  completed,  but  the  application  of  the  powder  should  never  be  used  as 
a  substitute  for  the  efficient  employment  of  the  warm  towel.  Special 
attention  should  be  given  to  the  folds  of  the  legs  and  arms,  and  to  the 
recesses  behind  the  ears.  After  washing  and  drying  the  invalid  care¬ 
fully,  the  nurse  should  brush  and  dress  the  hair,  and,  when  necessary, 
attend  to  the  teeth  and  mouth  ;  and  the  patient  should  be  made  general¬ 
ly  as  “tidy”  as  possible.  A  habitual  appearance  of  comfort  and  neat¬ 
ness  in  the  patient  will  always  reflect  credit  on  the  nurse. 

In  the  case  of  young  children,  who  can  be  handled  easily  and  dried 
quickly,  the  ordinary  warm  bath  may  be  used  for  ablution,  even  in 
serious  illness.  Care  must,  however,  always  be  taken  in  using  it  to 
regulate  the  temperature  of  the  water  accurately  with  the  thermome-- 
ter  ;  the  medical  attendant  will  generally  prescribe  the  degree  of  heat 
most  suitable.  Where  no  special  reason  exists  to  the  contrary,  a  tem¬ 
perature  of  98°  F.  is  usually  eligible.  Unless  the  temperature  of  the 
room  is  high,  the  bath  should  be  given  in  front  of  an  open  fire,  as  there 
is  danger  of  chill  on  removal  from  the  bath,  resulting  from  rapid  evap¬ 
oration  of  the  water  on  the  surface  of  the  body.  To  assist  in  obviating 
this  risk,  the  child  immediately  on  being  taken  out  of  the  bath  should  be 
enveloped  in  a  soft  warm  towel,  and  no  part  of  the  body  should  be  left 
uncovered  until  the  drying  is  completed. 

Clothing  of  the  Invalid. — The  best  material  for  the  dress  of  chil¬ 
dren  confined  to  bed  is  merino  or  flannel.  The  qualities  sought  for  in 
the  dress  are  warmth,  lightness,  and  absorptive  power,  the  last  quality 
being  of  at  least  equal  importance  with  the  first.  From  the  human  skin 
are  constantly  thrown  off  impure  secretions,  partly  in  the  form  of 
vapor,  partly  in  solution  and  suspension  in  the  fluid  perspiration. 
Unless  these  secretions  are  properly  absorbed  by  the  clothing,  they 
condense  and  dry  upon  the  surface  of  the  skin,  interfering  very  materi¬ 
ally  with  its  healthy  action.  As  an  absorptive  material,  merino  ha3 
some  advantages  over  flannel,  being  more  porous,  but  good  flannel 
possesses  the  three  qualities  required  in  reasonable  sufficiency.  The 
clothes  should  always  be  made  so  as  to  cover  properly  the  arms  and 
legs,  as  well  as  the  body.  In  young  children  it  is  convenient  to  have 


i78  hints  on  nursing  children  during  illness. 

the  night-dress  long  enough  to  admit  of  its  being  tied  in  the  form  of  a 
bag  beyond  the  feet,  when  there  is  a  tendency  to  become  uncovered 
through  restlessness. 

Whatever  the  material  chosen  may  be,  it  is  always  necessary  that 
the  dress  should  be  changed  with  sufficient  frequency  to  prevent  it 
becoming  disagreeably  charged  with  the  secretions  emanating  from  the 
skin.  The  vaporous  element  of  these  secretions  may  be  removed  by 
hanging  the  garment  in  a  current  of  fresh  air,  or  in  front  of  an  open 
fire ;  but  the  matter  suspended  in  the  fluid  portion  can  only  be  extracted 
by  careful  washing  of  the  clothing.  To  allow  of  the  frequent  removal 
of  the  gaseous  impurities,  it  is  desirable  always  to  have  two  dresses  in 
use  at  the  same  time,  one  for  the  day  and  one  for  the  night,  and  to  air 
each  well  in  front  of  a  fire  before  clothing  the  invalid  in  it.  As  the 
fluid  secretions  consist  largely  of  water,  it  must  always  be  borne  in 
mind  that  garments  when  taken  off  require  to  be  dried  well,  besides 
being  ventilated  thoroughly. 

Pood  of  the  Invalid. — Difficulties  of  feeding  do  not  present  them¬ 
selves  to  the  same  extent  in  the  illnesses  of  children  as  they  do  in  those 
of  adults.  For  the  nutrition  of  children,  in  disease  as  in  health,  milk 
is  the  sheet-anchor  upon  which  reliance  is  placed,  and  it  is  very  seldom 
that  absolute  distaste  of  this  food  is  observed,  unless  indeed  there  is 
actual  pain  in  the  act  of  swallowing,  from  irritability  of  the  throat  or 
mouth.  In  the  comparatively  few  instances  in  which  milk,  and  foods 
made  with  milk,  are  disliked,  recourse  must  be  had  to  chicken-tea, 
thickened  with  some  farinaceous  food,  preferably  one  of  the  malted 
foods ;  or  those  foods  may  be  given  made  with  water,  and  rendered 
more  nutritious  by  the  addition  of  a  small  quantity  of  cream.  The 
addition  of  a  little  isinglass  or  gelatine  also  aids  sometimes  their 
digestibility,  and  may  render  them  more  palatable. 

[The  white  of  egg  whipped  up  with  water,  using  two  eggs  to 
the  pint,  is  often  acceptable ;  or  barley-water,  made  by  boiling  two 
tablespoon fuls  of  barley  seed  in  a  pint  of  water  for  one  hour,  and 
then  straining.  This  may  be  flavored  with  orange.] 

In  all  cases  of  serious  illness,  the  nurse  ought  to  keep  a  written 
record  of  the  amount  of  food  actually  taken  by  the  child,  noting  the 
hour  at  which  each  quantity  is  taken.  Such  a  record  is  of  much  value 
to  the  medical  attendant  as  a  guide  to  the  proper  treatment  of  the 
patient. 

III.  The  administration  or  application  of  remedial  agents 

forms  the  third  head  under  which  the  duties  of  a  nurse  have  been 
classified.  As  the  administrator  of  disagreeable  medicine,  the  nurse 
probably  presents  her  least  popular  aspect  to  her  juvenile  patients. 
While  many  of  the  other  functions  of  a  nurse  toward  her  patients  are 
succeeded  at  once  by  increased  comfort,  and  are  recognized  by  chil- 


HOW  TO  GIVE  MEDICINES. 


179 


dreu  as  being  intended  for  their  well-being  and  happiness,  the  effect  of 
medicine  taken  internally  is  not  generally  so  immediate  as  to  demon¬ 
strate  to  the  young  patients  its  utility.  No  doubt  much  has  been  effect 
ed  of  late  years  in  making  medicines  in  a  more  palatable  form,  and  in 
facilitating  their  administration  ;  but  even  the  most  skilful  pharmacist 
finds  it  difficult  sometimes  to  disguise  the  taste  of  medicines,  the  use 
of  which  under  certain  circumstances  may  be  essential  to  recovery.  It 
is  in  the  administration  of  such  medicines  that  the  influence  a  good 
nurse  acquires  over  her  patient  exhibits  itself.  It  is  very  remarkable 
how  quickly  even  a  very  young  child  will  learn  to  appreciate  the  value 
of  a  nurse  who  does  her  work  well,  and  will  undergo  unpleasantness  if 
assured  that  benefit  is  to  be  derived  from  it.  To  acquire  this  influence 
a  nurse  must  not  only  know  her  duties,  but  must  also  have  gained  the 
confidence  of  her  patient  by  absolute  truthfulness.  Children  arc 
most  sensitive  in  this  respect,  and  if  a  nurse  is  foolish  enough  to  induce 
a  child  to  take  for  the  first  time  a  disagreeable  medicine,  on  her  false 
assurance  that  it  is  pleasant,  she  will  create  a  want  of  trust  which  will 
ever  afterward  diminish  her  usefulness.  Children  of  from  one  to  two 
years  are  quite  old  enough  to  comprehend,  when  they  are  told  that 
something  unpleasant  has  to  be  done  to  gain  future  benefit ;  and  if  they 
have  not  been  already  “spoilt”  in  some  way,  as  a  rule  they  will  sum¬ 
mon  up  their  courage  to  do  the  disagreeable  thing,  relying  with  confi¬ 
dence  on  the  assurance  of  the  nurse  whom  they  have  learnt  to  trust. 

In  the  administration  of  mixtures,  perception  of  the  taste  is 
much  diminished  by  giving  immediately  before  and  immediately  after 
the  medicine  a  little  milk  or  water.  The  milk  or  water  taken  immedi¬ 
ately  before  the  mixture  forms  a  thin  coating  over  the  tongue  and  palate 
which  protects  them  from  the  medicine,  and  that  following  its  inges¬ 
tion  carries  away  any  trace  which  may  be  left  of  its  taste.  This  method 
is  also  particularly  applicable  to  oils,  such  as  castor  and  cod-liver  oils. 
Castor-oil  is  a  medicine  which  has  often  to  be  administered  to  children, 
and  which  is  usually  rather  repulsive  to  them.  If  the  quantity  to 
be  given  is  poured  into  the  centre  of  a  little  milk  in  a  glass,  and  some 
water  taken  immediately  before  and  after,  the  taste  of  the  oil  will  often 
not  be  perceived  at  all.  Cod-liver  oil  is  often  rather  liked  by  children, 
when  only  a  small  quantity  is  given  at  first,  and  gradually  increased  ; 
when  it  is  disliked,  it  may  be  given  similarly  to  castor-oil,  or  a  little 
orange  wine  may  be  used  a3  a  vehicle  in  place  of  milk. 

Powders  are,  as  a  rule,  best  given  mixed  with  a  very  little  water 
in  a  spoon.  If  small,  they  may  be  placed  in  the  middle  of  a  little  jelly, 
or  may  be  mixed  with  some  sugar  and  taken  on  the  tongue  dry,  some 
water  being  swallowed  immediately  afterward.  Powders  are  occasion¬ 
ally  enclosed  in  gelatine  capsules  or  in  wafer  cachets,  but  it  is  difficult 
to  induce  children  to  swallow  these  whple?  and  if  broken  jdie  taste  of 


180  HINTS  ON  NURSING  CHILDREN  DURING  ILLNESS. 


the  powder  is  perceived  at  once.  This  remark  applies  also  to  the  com¬ 
pressed  tabloids  which  have  been  introduced  within  late  years,  and  to 
medicines  made  up  in  the  form  of  coated  pills.  As  a  rule,  there  is  no 
objection  to  giving  a  child  some  harmless  sweet  after  taking  medicine, 
and  if  its  taste  is  consulted  in  this  matter,  the  inducement  will  often 
be  sufficient  to  make  it  take  disagreeable  medicine  without  much 
reluctance. 

External  applications  are  made  use  of  to  a  very  considerable  ex¬ 
tent  in  the  treatment  of  disorders  in  children,  being  employed  for  four 
distinct  objects.  In  the  first  place,  they  are  used  for  the  purpose  of 
increasing  or  diminishing  the  temperature  of  any  part  of  the  body  ;  in 
the  second,  they  are  applied  in  order  to  maintain  the  moisture  of  any 
part ;  thirdly,  what  are  called  counter-irritating  applications  are  direct¬ 
ed  to  the  relief  of  pain  and  inflammation  ;  and  lastly,  medicated  prep¬ 
arations  are  applied  to  the  skin  in  order  that  they  may  be  absorbed, 
and  may  thus  exercise  their  special  medical  effects.  In  practice  it  is 
usually  convenient  and  advantageous  to  employ  applications  which 
combine  two  or  more  of  these  objects,  and  most  of  those  described  will 
be  found  to  do  this.  This  combination  which  is  most  frequently  called 
for  in  illness  in  children  is  the  application  of  heat  associated  with  moist¬ 
ure,  a  combination  usually  effected  by  the  use  either  of  warm  fomen¬ 
tations,  or  of  poultices  of  various  kinds. 

Warm  Fomentations. — A  piece  of  flannel  about  four  times  the 
size  of  the  surface  to  be  covered  with  the  fomentation  is  taken,  and 
folded  twice  upon  itself,  so  as  to  afford  a  pad  of  four  thicknesses  of 
flannel,  of  the  required  size.  This  pad  is  laid  upon  a  strong  towel, 
which  has  been  placed  across  an  empty  basin,  and  boiling  water  is 
poured  over  it  until  the  flannel  is  saturated,  any  surplus  water  running 
off  through  the  towel  into  the  basin  beneath  it.  Each  end  of  the  towel 
is  then  taken  hold  of  and  twisted,  so  that  the  flannel  is  wrung  out 
within  the  twists  of  the  towel.  The  towel  is  then  untwisted,  and  the 
flannel  taken  out  and  applied  to  the  invalid,  after  the  nurse  has  satis¬ 
fied  herself  that  it  is  of  proper  temperature.  The  flannel  is  immedi¬ 
ately  covered  with  a  piece  of  waterproof  sheeting  or  of  oiled  silk,  to 
prevent  evaporation  and  consequent  rapid  cooling,  and  to  protect  the 
dress  of  the  patient  from  moisture.  When  applied  efficiently  in  this 
manner,  flannel  often  affords  great  comfort,  and  is  preferable  to  poul¬ 
tices  on  account  of  its  being  cleaner,  as  well  as  lighter  in  weight.  On 
the  other  hand,  it  does  not  retain  its  heat  so  long  as  a  well-made  poul¬ 
tice,  and  requires  consequently  to  be  more  frequently  replaced. 
Speaking  generally,  moist  applications  of  warm  flannel,  to  be  thorough¬ 
ly  effective,  should  be  renewed  every  half-hour.  They  ought  always 
to  be  prepared  in  the  immediate  vicinity  of  the  patient,  otherwise 
they  are  apt  to  cool  rapidly  in  being  carried, 


POULTICES. 


1S1 


A  material  called  spongio-pilin,  which  consists  of  a  thick  felt 
coated  on  the  outside  with  a  waterproof  layer,  is  occasionally  employed 
as  a  substitute  for  flannel  and  waterproof  sheeting,  being  saturated  with 
hot  water,  and  pressed  before  being  applied.  It  has  no  advantages  over 
flannel,  except  perhaps  that  of  convenience,  while  it  does  not  retain  its 
heat  so  long,  and  is  somewhat  apt  to  render  damp  the  clothes  of  the 
invalid. 

Poultices  may  be  made  with  a  variety  of  materials,  linseed  meal, 
oatmeal,  bran,  starch,  rice,  and  bread  being  all  made  use  of  under 
different  circumstances.  The  material  most  commonly  employed  for 
the  purpose  in  England  is  linseed-meal,  and  the  detailed  description  of 
poultice-making  which,  follows  applies  specially  to  this  material  ;  oat¬ 
meal  and  bran  poultices,  however,  are  made  in  an  exactly  similar  man¬ 
ner.  A  short  description  of  other  poultices  will  be  added,  and  their 
special  uses  will  be  mentioned. 

Linseed  Poultices. — To  make  an  ordinary  linseed-meal  poultice 
well,  it  should  be  made  quickly  ;  and  to  enable  one  to  do  this,  all  the 
materials  must  be  ready  before  the  actual  process  of  making  commences. 
To  begin  with,  there  must  be  something  as  a  basis  on  which  the  poul¬ 
tice  is  to  be  spread.  In  home  nursing,  the  material  most  commonly 
made  use  of  is  old  linen  or  cotton,  a  piece  of  which  is  cut,  rather  larger 
than  the  size  of  the  poultice  it  is  intended  to  receive.  Thick  brown 
paper  does  fairly  well  for  the  purpose,  but  the  edges  are  apt  to  be  felt 
slightly  rough  by  the  patient.  In  some  hospitals  ordinary  tow  is  used. 
A  bowl  or  basin,  proportioned  in  size  to  the  poultice  to  be  made,  is 
also  necessary,  and  a  wooden  or  metal  spoon  for  stirring  the  poultice 
properly.  A  little  hot  water  in  another  basin  or  cup  is  also  desirable, 
and  a  kettle  filled  with  absolutely  boiling  water  must  be  available. 
Everything  being  now  prepared,  a  certain  quantity  of  boiling  water 
is  poured  into  the  basin,  the  quantity  depending  upon  the  size  of  poul¬ 
tice  required,  and  being  learned  only  by  experience.  The  nurse  then 
takes  the  spoon  in  one  hand,  and  some  linseed  meal  in  the  other,  and 
1  Is  the  meal  fall  rapidly  into  the  water,  which  she  stirs  continually 
with  the  spoon.  Enough  meal  is  added  to  make  the  poultice  of  fair 
consistency,  and  the  mixing  should  be  completed  when  the  whole  of 
the  meal  has  been  added.  The  mixture  thus  made  is  then  spread  on 
the  linen  or  cotton  prepared  for  it,  and  the  surface  smoothed  over  by 
the  spoon,  dipped  into  the  hot  water  in  the  other  basin  or  cup.  The 
edges  of  the  linen  or  cotton  are  then  doubled  over  so  as  to  cover  the 
edges  of  the  poultice,  which  is  now  ready  for  use.  Nurses  differ  to 
some  extent  in  the  thickness  with  which  they  spread  the  poultice,  and 
one  or  two  considerations  have  to  be  kept  in  view  in  deciding  the  mat¬ 
ter.  The  more  thickly  it  is  spread,  the  longer  it  will  retain  its  warmth, 
but  its  weight  will  of  course  be  greater  ;  and  if  the  poultice  is  at  all  a 


z$2  hints  on  nursing  children  during  illness. 


large  one,  and  placed  on  a  part  where  the  weight  will  be  felt,  as  on  the 
front  of  the  chest,  the  weight  may  be  of  some  importance.  In  children, 
indeed,  if  there  exists  any  difficulty  of  breathing,  the  pressure  of  a 
heavy  poultice  on  the  chest  may  do  material  injury.  As  a  general  rule, 
about  half  an  inch  will  be  found  a  convenient  thickness,  if  the  poultice 
is  to  be  placed  in  a  position  where  pressure  will  not  be  injurious  ;  when 
the  poultice  is  one  of  exceptional  size,  or  is  to  be  placed  on  a  part  where 
pressure  may  do  harm,  a  thickness  of  a  quarter  of  an  inch  will  be  suffi¬ 
cient.  Linseed-meal  poultices  should  always  be  applied  without  any¬ 
thing  intervening  between  the  linseed  and  the  skin.  The  two  best  tests 
of  a  well-made  linseed-meal  poultice  are,  that  it  can  be  rolled  up  on 
itself  and  unrolled  again  without  any  damage  to  its  surface,  and  that 
it  can  be  applied  to  the  skin,  and  afterward  removed,  without  any  of  the 
poultice  remaining  adherent  to  the  skin.  Sometimes,  when  the  linseed- 
meal  is  rather  dry,  a  little  olive  or  linseed  oil  will  require  to  be  added 
to  the  poultice  after  it  has  been  thoroughly  mixed,  in  order  to  attain 
the  degree  of  perfection  indicated.  It  should  be  remarked  that  com¬ 
monly  two  different  preparations  of  linseed  are  sold  under  the  name  of 
linseed-meal.  The  first  kind  is  sometimes  called  also  “crushed  lin¬ 
seed,”  and  is  simply  the  pure  linseed  crushed  and  bruised  into  a  condi¬ 
tion  of  meal ;  the  other  is  a  powder  made  by  grinding  linseed  cakes 
(which  are  commonly  called  oil- cakes),  from  which  the  linseed-oil  has 
been  expressed  by  pressure.  The  former  is  naturally  the  softer  and 
more  oily,  but  is  apt  to  ferment  and  become  somewhat  rancid  ;  when 
used  for  poultices,  care  should  be  taken  to  obtain  it  quite  fresh.  The 
second  is  the  more  eligible  preparation  ;  and  when  it  has  been  rendered 
too  dry  by  excessive  pressure  to  extract  the  oil,  the  addition  of  a  little 
fresh  linseed-oil  to  the  poultice  removes  the  defect.  Poultices  retain 
their  warmth  considerably  longer  than  flannel  wrung  out  of  hot  water, 
and  accordingly  do  not  require  to  be  replaced  so  frequently.  If  well 
made  and  of  considerable  thickness,  especially  when  protected  on  their 
outside  by  flannel,  or  wool  tissue,  or  thin  waterproof  sheeting,  it  will 
not  usually  be  found  necessary  to  change  them  more  often  than  once 
every  three  hours,  and  sometimes  they  will  retain  their  warmth  even 
longer  than  that  period. 

Bread  Poultices  are  best  made  from  the  crumb  of  stale  bread, 
which  should  be  powdered  and  stirred  into  boiling  water,  the  dish  in 
which  it  is  made  being  afterward  allowed  to  stand  in  boiling  water 
for  five  minutes,  to  allow  the  bread-crumb  to  swell  thoroughly.  They 
are  usually  employed  only  when  very  small  poultices  are  required, 
being  especially  useful  for  application  to  the  eyelids  in  inflammatory 
conditions.  Unlike  linseed  poultices,  bread  poultices,  may  be  made  in 
bulk  and  kept  warm  or  reheated,  so  that  they  are  convenient  for  use 
when  very  frequent  change  of  the  poultices  is  considered  desirable. 


HOT  AND  COLD  APPLICATIONS. 


They  should  always  be  applied  directly  to  the  skin,  without  any  inter¬ 
vening  tissue.  Occasionally  milk  is  made  use  of  in  their  preparation 
in  place  of  water,  increasing  to  some  extent  the  soothing  qualities  of 
the  poultices. 

Starch  Poultices  are  used  mainly  for  allaying  irritation  of  the 
skin  in  various  skin  diseases.  The  starch  is  powdered  and  mixed  with 
cold  water,  and  then  boiled  for  a  few  minutes  until  a  proper  consistence 
is  attained.  It  is  spread  for  use  upon  some  linen  or  cotton,  and  applied 
warm  directly  to  the  skin. 

Application  of  Dry  Heat. — Heat  without  moisture  is  not  unfre- 
quently  employed  for  the  purpose  of  maintaining  or  restoring  the 
natural  temperature  of  any  part  of  the  body,  when  the  circulation  has 
been  locally  enfeebled,  or  when  any  chill  has  been  experienced.  It  is 
most  conveniently  applied  by  means  of  flannels  heated  at  a  fire,  or 
rolled  round  a  hot  brick,  or  a  bottle  filled  with  water  ;  or  by  the  use  of 
small  bags  filled  with  sand  or  salt  which  has  been  heated  in  an  oven, 
previously  to  being  poured  into  the  bags.  In  making  such  applications, 
great  care  must  be  taken  that  the  amount  of  heat  is  not  sufficient  to  do 
any  injury.  The  nurse  should  always  test  the  temperature  with  her  cheek 
or  with  the  back  of  her  hand,  bearing  in  mind  that  the  heat  takes  some 
little  time  to  penetrate  through  a  few  thick  folds  of  flannel.  Especial 
care  is  requisite  in  cases  of  disease  of  the  nervous  system  involving 
paralysis,  in  some  instances  of  which  the  reaction  to  heat  is  excessive, 
while  the  sensitiveness  is  diminished  or  lost,  so  that  severe  injury  may 
result  from  excess  of  heat  while  the  invalid  is  quite  unconscious  of  any 
discomfort. 

Cold  applications  are  very  frequently  employed  both  for  the 
relief  of  pain,  and  in  the  treatment  of  local  and  general  diseases.  The 
simplest  way  of  applying  cold  to  any  part  of  the  body  is  by  placing 
upon  it  thin  cloths  wetted  with  cold  water,  and  changed  as  often  as 
they  become  either  warm  or  dry.  Such  applications  cool  the  part  on 
which  they  are  placed  in  two  different  ways.  In  the  first  place,  the 
water  by  which  they  are  saturated  is  cooler  than  the  skin  to  which  they 
are  applied,  and  when  placed  in  contact  with  it  absorbs  some  heat 
from  it.  In  the  second  place,  water  exposed  to  air  evaporates  rapidly, 
and  this  process  of  evaporation  is  accompanied  by  considerable  abstrac¬ 
tion  of  heat  from  surrounding  parts,  and  especially  from  the  part  with 
which  the  water  is  in  contact.  It  will  be  obvious,  therefore,  that  to 
utilize  both  these  methods  of  cooling  the  part,  the  cloth  which  is 
saturated  with  the  water  must  be  thin,  and  must  be  freely  exposed  to 
the  air,  so  as  to  admit  of  rapid  evaporation.  For  ordinary  purposes 
part  of  a  linen  handkerchief  folded  double  answers  very  well ;  and  the 
changes  must  be  made  as  frequently  as  it  is  found  to  become  warm, 
and  thus  to  lose  its  power  of  abstracting  heat  directly  from  the  part. 


:84  HINTS  ON  NURSING  CHILDREN  DURING  ILLNESS. 

It  will  not  unfrequently  be  found  that  the  changes  have  to  he  made  so 
often  as  to  become  tedious  both  to  the  invalid  and  to  the  nurse,  and 
some  other  device  lias  to  be  adopted  to  attain  the  same  result.  It  will 
be  perceived  that  the  same  object  would  be  achieved  if  a  constant 
supply  of  fresh  cold  water  could  be  conveyed  to  the  folded  handker¬ 
chief,  the  water  as  it  becomes  warmer  being  removed  by  evaporation, 
and  replaced  by  the  fresh  supply.  This  is  not  difficult  to  arrange  by 
means  of  a  thin  skein  of  cotton  or  worsted,  and  a  small  jar  or  jug  to 
hold  the  water.  If  the  jar  be  suspended  beside, the  patient  a  little 
higher  than  the  part  to  be  kept  cool,  filled  with  cold  water,  and  a  skein 
of  worsted  or  cotton  be  carried  from  it  to  the  folded  handkerchief, 
immersed  at  one  end  in  the  water  in  the  jar,  and  in  contact  with  the 
handkerchief  at  the  other  end,  a  constant  stream  will  flow  from  the  jar 
to  the  handkerchief,  wdiich  will  be  thus  kept  always  wret.  The  volume 
of  the  stream  will  depend  mainly  on  the  thickness  of  the  skein,  and 
partly  on  the  difference  of  height  between  the  jar  and  the  handkerchief  ; 
by  altering  these  one  is  able  to  regulate  satisfactorily  the  amount  of 
water  supplied,  so  that  the  bed  of  the  patient  does  not  become  moist¬ 
ened.  It  is  well,  however,  for  a  careful  nurse  always  to  have  a  small 
piece  of  covered  mackintosh  sheeting  under  any  part  to  which  cold 
water  is  to  be  thus  applied. 

When  a  greater  degree  of  coldness  is  demanded,  the  water  may  be 
artificially  cooled  by  the  addition  of  ice,  or  of  some  salt  which  abstracts 
heat  from  the  water  during  solution,  such  as  chloride  of  ammonium  01 
nitrate  of  potash.  Or  the  same  result  may  be  attained  by  the  addition 
of  some  fluid  to  the  water  which  will  render  the  process  of  evaporation 
more  rapid,  such  as  methylated  spirit  or  vinegar.  A  still  further 
degree  of  cold  can  be  produced  in  any  part  of  the  body  by  the  applica¬ 
tion  of  melting  ice,  enclosed  in  some  form  of  waterproof  bag.  When 
ice  is  melting  into  water,  the  water  formed  remains  at  a  temperature 
just  above  32°  F.,  known  as  the  freezing-point,  until  every  fragment 
of  ice  has  melted  ;  so  that  if  ice  is  broken  in  pieces  and  placed  in  a  bag, 
a  very  uniform  low  temperature  is  maintained  as  long  as  the  process  of 
melting  is  proceeding.  India-rubber  bags  for  the  purpose  of  contain¬ 
ing  ice,  and  shaped  according  to  the  part  to  which  they  are  intended  to 
be  applied,  are  obtainable  from  surgical  instrument  makers  ;  but  it  is 
not  difficult  for  an  intelligent  nurse  to  improvise  a  bag  which  will  be 
quite  as  effective  as  those  sold  for  the  purpose.  In  some  cases  an 
ordinary  sponge-bag  will  suit  very  well,  the  mouth  of  it  being  carefully 
tied  round  a  large  cork,  after  the  ice  has  been  put  into  it.  Very  con¬ 
venient  ice-bags  can  be  made  by  the  nurse,  of  any  size  and  shape  re¬ 
quired,  out  of  thin  gutta-percha  tissue  sold  by  all  chemists,  the  edges 
being  cemented  together  by  the  application  of  chloroform.  The  gutta¬ 
percha  tissue  is  double,  and  cut  to  the  size  and  shape  wanted  ;  the  free 


THE  USE  OF  ICE. 


185 

edges  are  then  turned  over,  and  are  made  to  adhere  by  brushing  a  little 
pure  chloroform  quickly  along  them,  and  pressing  them  until  they  ad¬ 
here  firmly  together.  A  very  little  practice  will  give  the  necessary 
quickness  and  neatness  in  making  such  ice-bags,  and  they  will  be  found 
veiy  convenient  and  useful.  The  gutta-percha  tissue  used  for  the  pur¬ 
pose  should  always  be  good  and  comparatively  new,  otherwise  there 
will  probably  be  found  in  it  some  minute  holes  which  will  leak  un¬ 
comfortably  as  the  ice  melts. 

Ice  is  generally  bought  in  large  blocks,  and  it  will  fall  to  the  nurse 
to  break  these  blocks  into  small  lumps,  suitable  for  introduction  into 
the  bags.  This  is  best  done  with  a  small  hammer  and  some  pointed 
instrument,  such  as  a  bradawl  or  a  shoemaker’s  awl.  By  pressing  the 
point  of  the  awl  on  the  ice,  and  giving  a  smart  rap  on  its  head  with  the 
hammer,  the  block  will  be  found  to  split  quite  easily  into  small  frag¬ 
ments.  Until  the  ice  is  required,  it  is  best  left  in  the  original  large 
blocks,  melting  much  more  slowly  thus  than  when  broken  up.  The 
blocks  should  be  rolled  up  in  flannel,  and  placed  in  such  a  position  that 
the  water  resulting  from  their  melting  is  able  to  drain  away  as  quickly 
as  it  is  formed.  A  good  plan  is  to  tie  some  flannel  or  a  piece  of  blanket 
loosely  across  the  top  of  a  pail  or  deep  basin,  to  place  the  ice  in  the 
hollow  of  it,  and  to  cover  it  over  with  another  piece  of  the  same 
material.  At  first  sight,  it  may  appear  rather  unreasonable  to  “keep 
ice  warm”  in  this  way  ;  the  ground,  however,  for  doing  so  is  practically 
the  same  as  that  on  which  flannel  is  recommended  to  be  used  for  cloth¬ 
ing.  Flannel  is  a  bad  conductor  of  heat,  and. when  used  for  clothing 
it  is  intended  to  prevent  the  escape  of  heat  from  the  body  ;  in  the  case 
of  ice  it  is  intended  to  prevent  the  admission  of  heat  to  the  ice,  in  both 
cases  equally  impeding  the  transmission  of  heat. 

In  certain  cases  of  essential  fever,  and  more  particularly  in  scar¬ 
let  fever  and  typhoid  fever,  wdien  the  temperature  tends  to  become 
dangerously  high,  it  is  usual  to  attempt  its  reduction  by  the  application 
of  cold  to  the  ichole  body  of  the  patient,  and  it  is  necessary  for  a  nurse  to 
know  how  to  carry  out  this  treatment  when  ordered  by  the  physician 
in  attendance.  Some  reduction  of  temperature,  and  considerable  gain 
in  comfort  -to  children  suffering  from  febrile  illness,  is  obtained  by 
frequent  sponging  with  cold  water,  to  which  is  sometimes  added  with 
advantage  a  small  quantity  of  vinegar.  The  effect  of  the  sponging  in 
diminishing  temperature  is  increased  if  the  patient  is  not  dried  for  two 
or  three  minutes  after  the  sponging,  the  evaporation  from  the  skin 
being  useful  in  promoting  the  abstraction  of  heat. 

When  cold  sponging  is  not  sufficient  to  lower  the  temperature,  a 
fact  to  be  ascertained  by  the  use  of  the  clinical  thermometer  before  and 
after  its  employment,  recourse  is  often  had  to  packing  in  a  sheet  wrung 
out  of  cold  water.  To  carryout  this  treatment,  satisfactorily,  the  bed 


1 86  HINTS  ON  NURSING  CHILDREN  DURING  ILLNESS 


of  the  patient,  or  where  possible,  another  bed  in  the  same  room,  must 
be  specially  prepared  by  having  a  waterproof  sheet,  with  a  blanket 
above  it,  spread  over  the  sheet  upon  which  the  invalid  usually  lies. 
While  the  patient  lies  on  this,  covered  with  another  blanket,  a  sheet  is 
taken  and  soaked  in  cold  water,  wrung  gently  so  as  only  to  press  out 
the  excess  of  water,  and  then  folded  round  the  invalid,  underneath  the 
blanket  with  which  he  is  covered.  Reduction  of  temperature  is  observed 
by  occasional  use  of  the  clinical  thermometer,  and  when  the  sheet  be¬ 
comes  warm  by  contact  with  the  body,  it  is  replaced  by  another  treated 
in  the  same  way  ;  this  is  repeated  until  the  required  reduction  in  tem¬ 
perature  is  attained.  The  patient  is  then  dried,  and  the  bed  restored 
to  its  original  condition  •  or,  where  a  second  bed  has  been  made  use  of, 
he  is  carried  back  to  the  one  from  which  he  was  taken.  It  is  not 
usually  considered  desirable  to  take  advantage  of  the  cooling  effects  of 
evaporation  in  this  treatment  ;  the  reduction  of  temperature  is  effected 
almost  entirely  by  the  actual  contact  of  cold  water  with  the  patient. 

The  application  of  simple  moisture,  independently  of  increased 
or  diminished  temperature,  is  frequently  desirable  in  the  treatment  of 
some  internal  diseases,  as  well  as  in  the  case  of  external  wounds.  This 
is  usually  effected  by  means  of  what  are  termed  compresses,  which 
consist  of  linen  or  cotton  or  lint  folded  in  one  or  two  thicknesses,  dipped 
in  warm  water,  and  covered  with  oiled  silk  or  gutta-percha  tissue. 
If  lint,  which  is  the  best  of  the  three  materials  mentioned  for  the  pur¬ 
pose,  is  employed,  it  is  generally  sufficient  to  use  it  of  only  double 
thickness.  The  doubled  lint  is  cut  to  the  size  required  for  the  com¬ 
press,  and  a  piece  of  oiled  silk  or  gutta-percha  tissue  is  cut,  so  that  its 
edges  overlap  in  every  direction  the  lint  by  from  a  quarter  to  half  an 
inch.  The  lint  is  then  soaked  in  warm  water,  and  laid  on  the  oiled  silk 
or  gutta-percha  tissue,  the  overlapping  edges  of  which  are  folded  over 
so  as  to  cover  in  the  edges  of  the  lint,  and  if  necessary  stitched  in  posi¬ 
tion.  The  compress  is  then  applied  to  the  part  desired,  and  secured  in 
its  place  by  a  thin  flannel  or  calico  bandage.  Compresses  of  this  kind 
are  very  valuable  in  many  cases  of  inflamed  throat,  being  applied  from 
ear  to  ear  under  the  chin,  and  secured  by  a  bandage  over  the  head. 
When  the  compress  is  used  for  application  to  a  wound,  it  is  better  not 
to  double  the  edges  of  the  gutta-percha  tissue  or  oiled  silk  inward  ; 
but  having  cut  the  lint  to  the  exact  size  of  the  wound,  to  make  the 
tissue  overlap  a  little  all  round,  the  overlapping  part  resting  on  the 
healthy  skin  around  the  wound.  Compresses  do  not  require  frequent 
changing ;  if  the  oiled  silk  is  properly  applied  so  as  to  completely 
cover  the  lint,  they  will  remain  quite  moist  for  more  than  twelve  hours. 
Treatment  by  counter-irritation  is  founded  partly  on  the  scien¬ 
tific  knowledge  that  irritation  excited  on  an  external  part  of  the  body 
relieves  the  congestion  of  blood  which  accompanies  inflammation  in  a 


STIMULATING  LINIMENTS  AND  PLASTERS. 


tS7 

neighboring  internal  part,  by  diverting  a  portion  of  the  supply  of 
blood  directed  to  it,  and  partly  on  empirical  experience  that  the  dis¬ 
comfort  and  pain  of  internal  inflammation  is  relieved  by  external  irrita¬ 
tion.  The  empirical  experience  will  be  obvious  to  any  one  who  has 
applied  whiskey  or  iodines  to  the  gum  for  the  relief  of  incipient  gum¬ 
boil.  The  amount  of  irritation  which  it  is  desirable  to  apply  in  any 
particular  case  to  the  external  surface,  will  vary  with  the  extent  and 
character  of  the  internal  inflammation  which  it  is  intended  to  affect 
and  remedy  ;  and  to  some  degree  also  with  what  the  patient  is  able  to 
bear.  As  a  general  rule,  it  may  be  stated  that  the  greater  the  extent  of 
skin  over  which  it  is  intended  to  apply  the  counter-irritant,  the  less  the 
amount  of  irritation  set  up  ought  to  be.  A  very  mild  mustard  poultice 
may  be  used  to  cover  the  whole  of  the  chest  and  back  of  an  invalid, 
while  a  pure  mustard  plaster  would  only  be  applied  to  a  small  part  of 
the  chest  at  one  time,  and  that  part  would  be  allowed  to  recover  to  some 
extent,  before  the  plaster  was  repeated  on  another  part  of  the  skin. 
Simple  counter-irritation  in  children  is  generally  effected  either  by 
friction  with  some  stimulating  liniment,  such  as  ammonia  or  turpentine 
liniment,  or  by  the  application  of  an  irritant  plaster,  such  as  that 
made  of  mustard  or  capsicum. 

Stimulating  Liniments. — Some  little  skill  and  practice  are  re¬ 
quired  before  a  nurse  can  make  effective  use  of  liniments  which  are  in¬ 
tended  to  be  applied  by  friction.  Much  the  most  effective  means  of 
using  them  is  by  me  uncovered  hand.  A  little  of  the  liniment  is  poured 
into  the  palm  of  the  hand  very  slightly  hollowed,  and,  being  conveyed 
to  the  part  to  which  it  is  to  be  applied,  is  rubbed  into  the  skin  by  gentle 
but  firm  and  uniform  friction.  This  friction  may  either  be  in  a  circular 
direction  or  upward  and  downward,  according  to  the  part  where  the 
application  is  made  ;  in  some  cases,  friction  only  in  one  direction  is 
permissible,  and  then  the  hand  must  be  lifted  from  the  skin  to  return 
to  the  starting-point.  On  the  chest  and  abdomen  circular  friction  is 
generally  best,  on  the  lower  part  of  the  back  the  friction  should  be  up¬ 
ward  and  downward,  and  on  the  legs  and  arms  usually  only  up¬ 
ward.  The  amount  of  liniment  to  be  rubbed  in,  and  the  length  of 
time  whiclris  to  be  devoted  to  the  rubbing,  must  vary  so  much  with 
individual  cases  that  no  general  rule  can  be  given.  As  the  friction  has 
usually  a  pleasant  and  somewhat  soothing  effect,  the  patient  is  not 
likely  to  complain  of  some  time  being  occupied  by  it ;  but  unless  a 
nurse  is  practised  in  the  process,  she  will  find  the  fatigue  considerable 
after  a  few  minutes.  , 

Mustard  plasters  are  prepared  by  spreading  on  some  base,  such 
as  brown  paper  or  thick  linen  or  cotton,  or,  what  is  best  of  all,  a  few 
layers  of  tissue  paper,  a  thin  coat  of  mustard  which  has  been  mixed 
with  water,  exactly  as  mustard  is  commonly  prepared  for  use  as  a  con- 


i88  HINTS  ON  NURSING  CHILDREN  DURING  ILLNESS. 


diment.  Care  must  be  taken  to  elicit  the  strength  of  the  mustard  by 
thorough  mixing  ;  and  it  should  be  spread  uniformly  to  the  size  re¬ 
quired,  with  the  thickness  of  about  one-tenth  of  an  inch.  The  edges 
of  the  base  should  then  be  turned  over,  to  prevent  the  escape  of  any 
„  mustard,  and  the  surface  should  be  covered  with  one  layer  of  tissue 
paper,  or  of  very  thin  linen  or  fine  muslin,  before  the  plaster  is  applied 
to  the  skin.  Usually  from  fifteen  to  twenty  minutes’  application  will 
produce  the  desired  amount  of  counter-irritation. 

For  the  application  of  counter-irritation,  in  combination  with  the 
soothing  and  curative  effects  of  heat  and  moisture,  it  is  usual  to  make 
use  of  either  mustard  poultices,  or  turpentine  stoups,  made  of  warm 
moist  flannels  sprinkled  with  turpentine.  Spongio-piline  wrung  out  of 
hot  water  and  sprinkled  with  turpentine  is  also  an  excellent  appliance 
for  carrying  out  this  treatment. 

Hustard  Poultices  are  generally  made  of  either  linseed-meal  or 
oat-meal,  combined  with  mustard  in  varying  proportions.  For  chil¬ 
dren  a  common  proportion  is  one-fourtli  of  mustard  to  three-fourths  of 
meal  ;  a  poultice  of  this  strength  will  usually  be  borne  well  for  an  hour 
at  a  time,  and  will  act  as  a  very  efficient  counter-irritant.  For  young 
babies  a  proportion  of  one-fiftli  of  mustard  will  generally  be  quite 
sufficient.  The  most  usual  method  of  making  them  is  to  mix  the 
mustard  and  meal  first,  and  then  to  add  boiling  water  with  constant 
stirring  until  the  poultice  arrives  at  the  proper  consistency.  This  is 
not,  however,  the  best  wa}T,  as  mustard  does  not  yield  readily  the 
essential  oil,  upon  which  its  strength  depends,  to  boiling  water.  A 
better  way  is  to  mix  the  mustard  well  first  with  cold  water,  then  to  add 
the  boiling  water,  and  proceed  to  make  the  poultice  by  adding  the  meal 
as  was  described  in  making  linseed  poultices.  Or,  in  accordance  with 
the  directions  of  the  “British  Pharmacopoeia,”  the  poultice  may  be  made 
first  as  a  linseed  poultice,  and  the  mustard  then  added  and  mixed  well 
with  much  stirring.  The  central  fact  to  be  kept  in  view  is  that  the 
strength  of  mustard  has  to  be  developed  by  intimate  mixture  with 
water  ;  and  that  the  greater  part  of  the  effect  of  it  is  lost,  unless 
care  be  taken  in  its  preparation.  Mustard  poultices  should  be  applied, 
like  linseed  poultices,  directly  to  the  skin  of  the  invalid. 

Turpentine  stoups  are  made  by  sprinkling  warm  moist  flannel 
prepared  as  has  been  described  on  page  180,  with  a  small  quantity  of 
pure  turpentine.  The  quantity  will  vary  with  the  size,  and  with  the 
degree  of  irritation  desired  ;  it  will  generally  be  found  that  half  a 
teaspoonful,  sprinkled  carefully  'wer  a  square  foot  of  flannel,  will  be 
sufficient  to  produce  within  an  hour  decided  redness  of  the  skin,  with 
some  feeling  of  heat  and  irritation.  Care  must  be  taken  that  the  tur¬ 
pentine  is  distributed  equally  over  every  part  of  the  surface,  and  that 
the  flannel  is  not  allowed  to  become  cool  before  being  applied.  After 


LOTIONS  FOR  EYES,  EARS  AND  THROAT. 


189 

the  amount  of  irritation  desired  has  been  attained,  it  may  be  kept  up 
for  an  indefinite  time  by  further  applications  of  stoups  prepared  with  a 
diminished  quantity  of  turpentine,  or  by  a  succession  of  simple  warm 
fomentations. 

When  spongio=piline  is  employed  it  is  sprinkled  with  turpentine 
exactly  in  the  same  way  as  the  flannel,  after  being  dipped  in  very  hot 
water  and  pressed. 

Lotions  are  usually  employed  in  a  manner  similar  to  the  water 
used  for  the  purpose  of  maintaining  simple  moisture,  as  described  on 
page  18G,  the  lint  being  saturated  with  the  lotion,  and  covered  over 
with  oiled  silk  or  gutta-percha  tissue  ;  sometimes  they  are  simply 
dabbed  on  and  allowed  to  dry.  In  the  application  of  lotions  to  the  eyes , 
it  is  most  convenient  to'  use  a  small  piece  of  absorbent  cotton-wool, 
which  is  saturated  with  the  lotion,  and  used  like  a  sponge  for  bathing 
the  eyes.  It  is  usually  necessary  that  some  of  the  lotion  should  go  in¬ 
side  the  eyelids  to  be  thoroughly  effective  ;  this  is  easily  managed  by 
drawing  downward  the  lower  eyelid  with  the  finger,  and  at  the  same 
time  squeezing  the  cotton-wool  a  little,  so  that  a  few  drops  of  the  lotion 
fall  from  it  into  the  eye.  No  injury  can  possibly  result  from  drawing 
down  the  eyelid  in  this  way,  if  care  is  taken  to  rest  the  finger  not  on 
the  eye  itself,  but  on  the  ridge  of  bone  which  projects  below  the  eye. 

The  interior  of  the  ears  has  occasionally  to  be  syringed  with  warm 
water,  or  with  prescribed  lotions.  The  most  convenient  syringe  for 
the  purpose  is  one  made  of  a  small  india-rubber  ball,  with  a  glass  or 
ivory  ear-piece  attached.  This  is  filled  by  immersing  the  end  of  the 
ear-piece  in  the  water  or  lotion,  and  after  compressing  the  ball  to  empty 
it  of  air,  allowing  it  to  expand  so  as  to  draw  into  it  the  fluid  which  is 
to  be  employed.  The  ear -piece  is  then  directed  to  the  entrance  of  the 
ear,  but  not  pressed  into  it,  and  the  ball  being  compressed,  the  fluid  is 
injected  into  the  ear,  running  out  again  after  it  has  reached  the  drum 
of  the  ear,  at  the  farther  end  from  the  external  opening.  A  small  bowl 
should  be  held  under  the  ear  to  receive  the  returning  fluid.  In  very 
young  children  it  will  be  found  most  convenient  to  syringe  their  ears 
when  in  their  bath,  and  then  no  bowl  need  be  used  to  receive  the  re¬ 
turning  injection. 

Applications  to  the  interior  of  the  throat  are  best  made  with  a 
camel’s-hair  brush  fitted  with  a  straight  handle.  If  the  child  has  been 
taught  to  open  its  mouth  properly,  very  often  it  will  not  be  necessary 
to  use  any  means  for  depressing  the  tongue  ;  if,  however,  the  throat 
cannot  be  seen  on  account  of  the  tongue,  the  handle  of  a  teaspoon 
should  be  used  to  press  it  downward.  The  child  should  be  placed 
facing  a  window,  while  the  nurse  takes  the  brush  in  one  hand  and  the 
teaspoon  in  the  other,  and  immediately  on  depressing  the  tongue,  paints 
with  the  solution  the  part  of  the  throat  which  requires  attention.  The 


I9o  HINTS  ON  NURSING  CHILDREN  DURING  ILLNESS. 

essential  qualities  for  success  in  this  little  operation  are  quickness  and 
neatness.  If  the  brush  is  soft,  there  is  no  risk  whatever  of  doing  any 
injury  to  the  throat ;  and  the  more  quickly  the  painting  is  effected,  the 
less  will  the  child  usually  resent  the  process. 

Precaution  Relating  to  Infectious  Diseases. — On  the  occurrence 
of  infectious  disease  in  a  house,  it  sometimes  falls  to  the  duty  of  the 
nurse  to  make  arrangements  for  the  isolation  of  the  patient,  in  order 
to  prevent  the  spread  of  the  infection.  To  be  effective,  isolation  must 
always  be  thorough  and  complete.  The  patient  and  the  nurse  should 
be  allotted  one  or  two  rooms,  or,  when  possible,  a  whole  floor  of  the 
house  ;  and  no  one  else  in  the  house  should  be  permitted  to  enter  these 
rooms  on  any  pretext  whatever.  When  it  can  be  managed,  the  rooms 
should  be  separated  from  the  rest  of  the  house  by  a  large  sheet  of 
washable  material,  calico  or  cotton  being  the  most  suitable,  which 
should  be  kept  constantly  moist  with  water  mixed  with  some  disin¬ 
fectant  fluid,  such  as  a  weak  solution  of  carbolic  acid.  The  solution 
should  be  of  the  strength  of  about  one  part  of  the  disinfectant  fluid  to 
thirty  parts  of  water.  When  the  rooms  cannot  be  isolated  in  this  way, 
a  similar  sheet  should  be  fastened  outside  the  door  qf  each  of  the  rooms 
used  for  the  patient  and  nurse.  As  the  nurse  must  leave  the  isolated 
rooms  once  or  twice  daily  for  a  walk  and  for  other  necessary  purposes, 
a  washable  dressing  gown  or  other  garment,  which  is  large  enough  to 
completely  envelop  her,  should  be  placed  just  outside  the  isolated 
area  ;  and  this  should  be  put  on  by  the  nurse  each  time  she  leaves  the 
rooms,  and  put  off  again  before  she  enters  them.  When  leaving  the 
house  for  her  daily  w'alk,  the  enveloping  garment  should  accompany 
her  to  the  outside  door  of  the  house,  and  being  left  there,  should  be 
put  on  again  on  her  return.  Every  nurse  who  is  in  constant  attendance 
on  a  case  of  infectious  disease  should  be  made  to  take  a  walk  of  at  least 
an  hour  daily.  If  this  is  not  insisted  upon,  her  health  is  exceedingly 
likely  to  fail,  and  she  may  break  down  entirely  at  the  critical  period 
when  her  services  may  be  in  urgent  request.  For  the  purpose 
of  keeping  the  air  of  the  house  as  pure  as  possible,  reliance  must  be 
placed  on  the  most  thorough  ventilation  attainable.  On  the  floor  below 
vdiere  the  patient  is,  doors  and  windows  should  be  kept  widely  open 
throughout  the  day,  and,  so  far  as  the  season  will  permit,  during  the 
night  also.  The  windows  of  unoccupied  rooms  on  the  same  floor  as  the 
patient  should  also  be  utilized  for  ventilation. 

Disinfectants  in  Infectious  Diseases.— No  confidence  is  to  be 
placed  on  the  use  of  disinfectants  for  the  purpose  of  maintaining  the 
atmosphere  pure,  and  destroying  infectious  germs.  Currents  of  pure 
air,  and  as  much  sunshine  as  possible,  are  the  only  reliable  disinfectants 
of  the  air  of  inhabited  houses.  Disinfectant  and  antiseptic  fluids  can 
only  be  relied  on  when  used  in  solutions  of  proper  strength  for  wash- 


THE  USE  OF  DISINFECTANTS. 


191 

ing,  and  for  mixing  with  excreta  before  being  carried  out  of  the  room, 
but  they  cannot  be  added  to  respirable  air  in  sufficient  proportion  to 
have  any  real  disinfectant  power.  All  washable  clothing,  nightdresses, 
and  bed-linen  should  be  placed  in  linen  or  cotton  bags  when  dirty,  and 
should  be  boiled  thoroughly  before  being  sent  to  be  washed,  or,  where 
possible,  should  be  retained  in  one  of  the  isolated  rooms  until  the  illness 
is  over,  and  then  sent  away  for  disinfection.  Plates,  cups,  and  saucers, 
and  other  articles  containing  food  should  be  placed  by  the  nurse,  after 
the  food  is  consumed,  in  a  large  basin  or  small  tub  outside  the  door  of 
the  sick-room,  and  completely  immersed  in  a  solution  of  carbolic  acid 
of  the  strength  of  one  part  in  twenty  of  water. 

Water  which  has  been  used  in  washing  the  patient,  and  all  excreta, 
should  be  completely  disinfected  by  the  addition  of  carbolic  acid  in  a 
proportion  of  about  one  in  ten  parts,  before  being  removed  from  the 
room. 

The  one  risk  of  spreading  the  infection,  if  all  the  precautions 
mentioned  are  rightly  observed,  lies  in  the  passage  of  the  nurse  through 
the  house  when  going  to  and  returning  from  her  daily  walk.  This  is 
a  risk  which  must  be  incurred,  but  care  should  be  taken  to  minimize  it 
as  far  as  possible.  Before  leaving  the  rooms,  the  nurse  should  wash 
her  hands  and  face  carefully.  She  should  walk  straight  out  of  the 
house  without  stopping  to  speak  with  any  one,  and  any  conversation 
she  may  desire  should  take  place  after  her  return  from  the  walk,  be¬ 
fore  entering  the  invalid’s  rooms. 

When  the  illness  is  over,  and  the  risk  of  personal  infection  from 
the  invalid  gone,  he  should  be  taken,  in  as  little  clothing  as  possible, 
to  a  room  free  from  infection,  given  a  complete  bath  of  water  with 
carbolic  acid,  of  the  strength  of  about  one  in  forty,  the  hair  and 
the  head  being  washed  as  well  as  the  body,  and  then  clothed  in 
garments  which  have  not  been  exposed  to  the  risk  of  infection. 
The  clothing  in  which  he  was  brought  out  of  the  room  should 
be  returned  to  it,  and  left  there  until  room  and  clothing  are  subjected 
to  thorough  disinfection.  This  is  usually  undertaken  by  the  local 
sanitary  authorities. 

It  is  desirable  to  repeat  and  emphasize  the  fact  that  disinfectants 
can  never  occupy  the  place  properly  filled  by  fresh  air  and  perfect 
cleanliness  ;  they  can  only  at  best  act  as  adjuncts,  giving  some  ad¬ 
ditional  security  after  every  possible  care  has  been  taken  in  all  other 
respects. 

Abuse  of  Disinfectants. — In  the  nursing  of  non-infectious  cases 
the  use  of  antiseptics  and  disinfectants  is  generally  unnecessary,  and  is 
not  unfrequently  a  cloak  for  carelessness  in  cleanliness.  It  may  be 
laid  down  as  a  general  rule,  that  the  better  a  nurse  is,  the  smaller 
amount  of  disinfectants  and  antiseptics  she  will  employ. 


CHAPTER  XVII. 


Some  Minok  Troubles  of  the  Earlier  Months  of  Infant  Life. 


Separation  of  Stump  of  Umbilical  Cord;  Occasional  Ulceration ;  Treatment; 
Hernia  at  Navel;  Management;  Inflammation  of  Breasts;  Desquamation 
of  Skin;  Red-Gum;  Jaundice;  Yellow-Gum;  Thrush:  Its  Cause  and 
Treatment;  Diarrhoea;  Its  Causes  and  Treatment;  Erythema  and  Inter¬ 
trigo;  Sand  or  Gravel;  Constipation:  Its  Treatment;  Inflammation  of  Eye¬ 
lids;  Method  of  Applying  Lotions  to  Eye;  Closure  of  Lachrymal  Ducts; 
Vaccination. 

Separation  of  Umbilical  Cord. — In  connection  with  the  natural 

process  of  the  separation  of  the  stump  of  the  umbilical  cord  soon  after 
birth,  some  departures  front  the  normal  course  are  occasionally  en¬ 
countered.  When  the  separation  proceeds  healthily  the  stump  shrinks 
and  dries  in  two  or  three  days,  a  very  fine  line  of  ulceration  is  observed 
at  its  'junction  with  the  skin  of  the  abdomen,  and  when  it  drops  off  on 
the  fifth  or  sixth  day  after  birth,  a  small  circle  of  healthy  skin,  with 
a  minute  depression  in  the  middle,  is  seen  in  the  centre  of  the  abdomen, 
where  the  cord  was  previously  attached.  Sometimes  the  stump,  in¬ 
stead  of  drying,  becomes  more  moist  and  smells  somewhat  unpleasantly, 
indicating  the  existence  of  decomposition.  When  this  occurs  the  sep¬ 
aration  usually  progresses  more  slowly,  and  the  line  of  ulceration  be¬ 
comes  wider  and  more  obvious,  and  is  accompanied  not  unfrequently 
with  an  appreciable  discharge  of  unhealthy  matter.  The  best  treat¬ 
ment  for  this  condition  is  frequent  powdering  of  the  stump  with  some 
antiseptic  dry  powder,  such  as  boracic  acid  mixed  with  an  equal  quantity 
of  oxide  of  zinc  or  of  powdered  starch.  If  such  a  powder  be  dusted 
well  twice  daily  over  the  stump  and  the  skin  in  the  vicinity  of  its 
attachment  to  the  abdomen,  the  decomposition  is  usually  arrested,  and  the 
separation  proceeds  satisfactorily.  If,  after  the  separation  of  the  stump, 
a  small  ulcerating  surface  is  left  behind,  this  should  be  dusted  twice 
daily  with  the  same  powder.  Frequently  after  the  separation  of  the 
stump,  the  part  of  the  surface  of  the  abdomen  to  which  it  was  attached 
is  covered  over  by  a  fold  of  skin,  from  beneath  which  a  little  discharge 
may  be  seen  to  exude,  giving  rise  to  the  supposition  that  the  matter  is 
coming  actually  from  within  the  navel.  This  is  never  the  case  ;  when 
discharge  of  this  kind  is  seen,  the  source  of  it  will  always  be  found,  on 


HEKNIA  AT  THE  NAVEL. 


193 


stretching  the  skin  and  distending  the  navel,  in  a  small  ulcerating  sur¬ 
face  made  obvious  by  the  distention.  Very  frequently  this  surface 
takes  the  form  of  a  small  polypus  about  the  size  of  a  small  pea,  pro¬ 
jecting  from  the  central  depression  of  the  navel,  keeping  up  the  dis¬ 
charge,  and  causing  irritation  of  the  surrounding  skin  encircling  the 
navel.  In  treating  this  condition  with  antiseptic  powder,  care  must  be 
taken  that  the  powder  reaches  the  ulcerating  surface.  It  is  not 
sufficient  simply  to  dust  the  powder  over  the  skin  of  the  abdomen  ;  the 
navel  must  be  distended,  and  the  ulcerating  surface  brought  to  view 
before  the  powder  is  applied,  so  that  the  application  may  be  efficiently 
made.  When  the  use  of  the  powder  for  a  few  days  does  not  result  in 
complete  cure,  it  may  be  necessary  to  touch  the  surface  twice  daily 
with  some  astringent,  such  as  a  piecfe  of  blue  stone  (sulphate  of  copper) ; 
sometimes,  when  the  polypoid  growth  is  large,  it  is  desirable  to  re¬ 
move  it  by  tying  a  thread  tightly  round  it,  or  by  snipping  it  off  with 
a  pair  of  scissors. 


Umbilical  Hernia.— -In  infancy  there  is  often  a  strong  tendency  to 
the  development  of  hernia  at  the  navel.  The  wall  of  the  abdomen  at 
that  point  is  often  thin  and  elastic,  and  when  an  infant  cries  lustily,  a 
small  part  of  the  bowel  is  sometimes  pushed  through  the  weakened 
wall,  projecting  to  the  size  of  a  large  thimble  in  the  middle  of  the 
abdomen,  and  covered  only  by  thin  semitranslucent  skin.  This  form 

of  rupture  may  appear 
at  any  time  during  the 
first  year  of  life,  but  is 
much  more  common  in 
the  earlier  weeks.  Its 
presence  should  not  ex¬ 
cite  anxiety,  as,  when 


Fig.  26. 


UMBILICAL  BANDAGE  FOR  YOUNG  INFANTS. 


Fig.  27. 


treated  by  the  application  of  the  belt  de¬ 
scribed  in  Chapter  XV.,  recovery  in  time  is 
the  invariable  result ;  but  care  should  al¬ 
ways  be  taken  in  washing  the  infant  that  no 
injury  is  done  to  the  projecting  hernia. 

When  it  is  large,  and  appears  immediately 
on  the  removal  of  the  belt,  it  is  well  to  have  umbilical  bandage. 
a  special  india-rubber  belt  for  use  during  the  time  that  the  infant  is 
being  bathed,  replacing  this  by  the  ordinary  belt  when  he  is  removed 
from  the  bath  and  dried. 

Inflammation  of  the  Breasts  of  Infants. — Infants,  both  male  and 
female,  are  somewhat  apt  to  suffer  from  slight  inflammation  of  the 

breasts  within  a  few  days  after  birth.  The  nipples  and  the  small  • 

7 


194 


EARLIER  TROUBLES  OF  INFANT  LIFE. 


glandular  tissue  beneath  them  become  somewhat  swollen,  reddened, 
and  tender  to  touch,  and  occasionally  there  is  exudation  of  a  little 
fluid  having  some  of  the  properties  of  milk.  The  disturbance  rarely 
lasts  beyond  one  or  two  days,  and  only  exceptionally  calls  for  any 
treatment.  When  the  swelling  is  considerable,  gentle  rubbing  with 
olive-oil  [or  Magnetic  Ointment]  is  useful,  and  will  be  found  to  aid 
the  reduction.  Ignorant  nurses  sometimes  fancy  that  it  has  some  con¬ 
nection  with  the  development  of  the  gland  for  the  process  of  nursing 
in  later  life,  and  in  female  children  accordingly  “assist”  by  manipula¬ 
tion  which  not  unfrequently  results  in  severe  inflammation,  sometimes 
followed  by  abscess.  The  exact  cause  of  the  glandular  disturbance  is 
not  known,  but  its  occurrence  in  male  children  as  well  as  in  female 
seems  to  negative  the  hypothesis  of  the  nurses  described  above.  On  the 
other  hand,  mothers  who  are  not  aware  of  this  peculiar  tendency  to 
irritation  in  infant  life  are  occasionally  apt  to  attribute  its  occurrence 
to  carelessness  of  the  nurse,  and  to  hold  her  responsible  for  what  is 
really  a  somewhat  inexplicable  natural  phenomenon. 

Desquamation  of  Skin. — Reference  has  already  been  made  to  the 
desquamation  or  casting  of  the  skin  which  follows  within  two  or  three 
weeks  of  birth.  The  process  is  sometimes  very  obvious,  the  skin  peel¬ 
ing  off  in  very  apparent  shreds  ;  sometimes,  on  the  other  hand,  it  is  so 
gradual  and  slight  as  to  be  quite  unnoticed  except  by  a  careful 
observer.  Frequently  it  is  accompanied  by  some  irritation  of  the  skin, 
which  shows  itself  in  the  development  of  small  red  spots  scattered  over 
the  body.  These  spots  are  known  popularly  as  red-gum,  more 
scientifically  as  strophulus.  They  vary  in  size  from  a  pin’s  head  to  a 
split  pea,  or  even  more,  and  project  somewhat  from  the  skin,  forming 
up-raised  pimples.  Sometimes,  when  the  eruption  is  severe,  there  is 
a  little  watery  fluid  on  the  points  of  some  of  the  pimples,  giving  them 
the  appearance  of  small  vesicles.  These  pimples  are  generally  scattered 
over  the  greater  part  of  the  body  and  limbs,  and  last  for  a  few  days, 
gradually  fading  away.  It  is  very  seldom  that  they  seem  to  be  a 
source  of  discomfort  to  the  infant,  and  as  a  rule  no  treatment  what¬ 
ever  is  required. 

During  the  first  week  of  life  many  infants  exhibit  symptoms  of 
jaundice,  the  skin  and  the  white  part  of  the  eyes  becoming  stained  to 
a  deep  yellow  color.  The  cause  of  it  is  not  always  apparent,  but  in  some 
cases  at  least  it  seems  to  be  due  to  disturbance  of  the  stomach  from 
fluids  swallowed  during  the  process  of  birth.  Beyond  sometimes 
affecting  for  a  few  days  the  desire  for  food,  this  form  of  jaundice  does 
not  appear  injurious,  and  usually  disappears  in  from  a  week  to  ten 
days.  When  the  eruption  described  above  as  red-gum  makes  its 
appearance  while  an  infant  is  jaundiced,  the  spots  or  pimples  appear 
pf  a  more  pr  less  yellowish  color  ;  and  tlie  popular  names  of  yellow-* 


THRUSH  OF  MOUTH  AND  THROAT. 


*95 


gum  lias  been  applied  to  this  combination  of  jaundice  and  irritation  of 
the  skin.  No  treatment  is  required  for  this  form  of  jaundice  but  if 
the  infant  is  being  fed  artificially  some  difficulties  of  digestion  may 
present  themselves,  and  call  for  attention,  and  modifications  of  feed¬ 
ing  such  as  have  been  indicated  in  Chapter  XIII.  It  will  occasionally 
be  observed  that  during  the  existence  of  the  jaundice  the  urine  of  the 
infant  is  very  high-colored,  and  stains  deeply  the  napkins.  This  is  a 
natural  result  of  jaundice,  when  present  to  any  extent,  and  need  not 
give  rise  to  any  anxiety,  so  long  as  the  infant  seems  in  other  respects 
well,  and  maintains  its  appetite.  Jaundice  as  described  above  is  of 
short  duration,  never  probably  lasting  more  than  a  fortnight.  If  it 
continues  for  a  longer  period  than  this  it  is  likely  to  be  due  to  some 
more  serious  underlying  condition,  and  demands  medical  attention 
and  skill. 

Thrush  is  a  peculiar  form  of  inflammation  of  the  mouth  and 
throat  affecting  most  commonly  infants,  but  sometimes  also  older  chil¬ 
dren,  and  even  adults  when  in  a  weak  state  of  health,  characterized  by 
the  presence  of  a  minute  fungoid  growth  of  a  yellowish-white  color. 
If  the  interior  of  the  mouth  of  an  infant  suffering  from  thrush  be  ex¬ 
amined,  the  tongue,  the  interior  of  the  cheeks,  the  gums,  and  occasion¬ 
ally  the  throat,  will  be  observed  to  be  dotted  over  by  small  whitish 
patches,  like  small  flakes  of  curdled  milk.  Each  little  patch  is  sur¬ 
rounded  with  a  circle  of  deepened  red  color,  and  little  ulcerated 
points  may  be  noticed  here  and  there,  where  the  fungoid  growth  has 
separated  from  the  interior  lining  of  the  mouth.  Sometimes  the  patches 
of  white  growth  are  so  numerous  that  they  coalesce,  and  unite  into  a 
continuous  membrane  lining  a  considerable  part  of  the  mouth.  When 
the  patches  are  small,  and  the  surrounding  circles  of  darker  red  not 
very  marked,  they  may  be  easily  mistaken  at  first  sight  for  flakes  of 
curdled  milk  ;  but  the  distinction  is  made  without  difficulty  by  attempt¬ 
ing  to  remove  one  of  them  with  the  finger,  or  with  a  brush.  Flakes  of 
milk  are  removed  with  facility,  and  leave  a  perfectly  healthy  surface 
beneath  ;  while  the  patches  of  fungus  are  separated  with  difficulty,  and 
when  removed  a  small  superficially  ulcerated  surface  is  observed,  to 
which  the  fungus  had  been  attached.  The  inflammatory  patches  cov¬ 
ered  with  fungous  growth  may  continue  for  an  indefinite  period,  unless 
cured  by  appropriate  treatment.  They  frequently  extend  down  the 
back  of  the  throat,  and  in  severe  cases  affect  also  the  lining  membrane 
of  the  stomach.  When  the  disease  exists  to  any  extent  in  the  mouth 
there  is  usually  considerable  tenderness,  and  the  infant  suffers  pain 
when  sucking  the  bottle  or  the  breast,  not  unfrequently  declining  to 
suck  altogether  unless  very  hungry.  The  inflamed  condition  of  the 
mouth  is  almost  invariably  accompanied  by  some  degree  of  indigestion, 
the  evidence  of  which  is  found  in  symptoms  of  pain  after  the  admin* 


EARLIER  TROUBLES  OF  INFANT  LIFE. 


196 

istration  of  food,  occasional  sickness,  with  much  sourness  and  dis 
agreeable  odor  of  the  vomited  food,  and  relaxation  of  the  bowels 
amounting  frequently  to  diarrhoea.  The  motions  from  the  bowels  are 
generally  green  in  color  and  mixed  with  gelatinous  mucus,  and  are 
somewhat  irritating  to  the  skin  around  the  opening  of  the  bowel. 
This  often  consequently  becomes  reddened,  inflamed,  and  sometimes 
slightly  abraded,  an  appearance  which  has  given  origin  to  the  idea 
that  the  thrush  “  passes  through  ”  the  infant.  This  idea  is  erroneous, 
as  the  true  fungus  of  thrush  is  never  found  on  the  surface  of  the  skin, 
and  is  misleading  in  suggesting  the  appearance  of  the  skin  as  a  symptom 
of  improvement  in  the  condition  of  the  mouth. 

In  children  who  are  properly  taken  care  of,  thrush  is  very  seldom 
a  disease  of  much  severity ;  but  in  neglected  infants  it  is  not  un- 
frequently  the  cause  of  serious  illness,  and  even  of  death,  from  exhaus¬ 
tion  resulting  from  the  secondary  disorder  of  the  digestive  canal.  The 
importance  to  be  attached  to  it  depends  chiefly  on  the  amount  of 
gastric  disturbance  associated  with  its  development. 

The  initial  cause  of  thrush  in  infants  is  almost  invariably  some 
slight  disorder  of  digestion,  resulting  from  improper  food,  or  from 
food  improperly  administered.  It  is  exceedingly  rare  in  children  nursed 
exclusively  at  the  breast,  while  very  common  among  infants  brought 
up  on  any  kind  of  artificial  food  ;  and  when  it  occurs  its  severity  seems 
generally  to  be  in  proportion  to  the  carelessness  or  ignorance  of  the 
person  in  charge  of  the  infant.  Uncleanliness  of  bottles  and  nipples, 
and  the  use  of  india-rubber  tubing,  are  fertile  sources  of  thrush  in  hand- 
fed  children.  The  improper  or  uncleanly  food  seems  in  the  first  place 
to  cause  a  slight  irritation  of  the  lining  membrane  of  the  mouth,  which 
affords  a  favorable  site  for  the  adhesion  and  development  of  the 
fungus,  which  is  frequently  present  in  milk  ;  and  the  fungus,  having 
once  obtained  a  foothold,  increases  the  original  irritation,  and  spreads 
itself  gradually  over  the  mouth  and  throat.  Accepting  this  explana¬ 
tion,  it  is  obvious  that  the  best  way  to  prevent  the  occurrence  of  thrush 
is  to  conduct  the  artificial  feeding  of  an  infant  with  the  greatest  possible 
care  as  to  digestibility  and  to  cleanliness.  During  the  earlier  weeks 
more  especially  of  artificial  feeding,  at  which  time  thrush  is  most 
likely  to  occur,  symptoms  of  indigestion  such  as  sickness,  pain  after 
ingestion  of  food,  and  unhealthy  motions  from  the  bowels,  should  be 
watched  for,  and  treated  when  necessary  by  slight  alterations  either  of 
the  food  itself,  or  of  the  manner  of  administration.  The  interior  of 
the  mouth  should  be  examined  daily,  and  the  first  indication  of  the 
presence  of  thrush  should  be  met  by  suitable  treatment.  This  treat¬ 
ment  should  consist  both  of  attention  to  the  general  health,  and 
especially  to  the  digestion  of  the  infant,  and  of  local  treatment  to  the 
mouth  and  interior  of  the  cheeks  affected  with  the  fungus. 


TREATMENT  OE  THRUSH. 


197 


From  what  has  been  already  said  of  the  relation  of  thrush  to  in¬ 
digestion,  it  will  be  understood  that  generally  some  little  change  in  the 
form  of  food  will  be  indicated.  The  presence  of  thrush  practically 
proves  the  existence  of  some  previous  indigestion  ;  and  this  must  be 
combated  by  some  alteration  in  the  preparation,  or  the  form,  or  the 
dilution  of  the  artificial  food  supplied. 

The  Local  Treatment  to  the  mouth  consists  firstly  in  the  main¬ 
tenance  of  the  greatest  possible  cleanliness,  and  secondly  in  the  applica¬ 
tion  of  some  astringent  and  antiseptic  remedy.  If  an  infant’s  mouth 
be  examined  a  few  minutes  after  it  has  taken  food,  it  will  be  remarked 
that  a  little  of  the  food  remains  lurking  in  various  recesses  of  the 
mouth,  such  as  between  the  gums  and  the  cheeks,  or  under  the  tongue. 
When  thrush  is  present,  such  small  remnants  of  food  decompose 
rapidly,  and  not  only  increases  the  irritation  of  the  mouth  already  pres¬ 
ent,  but  also  afford  nourishment  for  the  fungus,  and  assists  its  growth. 
It  is  very  essential  therefore,  in  the  treatment  of  thrush,  to  clean  the 
mouth  of  the  infant  thoroughly  immediately  after  each  meal.  This 
is  best  effected  with  a  clean  handkerchief,  a  small  part  of  which  is 
dipped  in  clean  warm  water,  and  brushed  lightly  but  thoroughly  over 
and  around  the  interior  of  the  child’s  mouth.  When  the  mouth  has 
been  made  quite  clean,  a  little  glycerine  or  borax  should  be  applied  to 
the  interior  with  a  camel’s-hair  brush,  or  with  the  finger.  The  treat¬ 
ment  of  cleaning  the  mouth  thoroughly  and  applying  the  borax  should 
be  continued  assiduously  after  each  meal,  until  all  traces  of  the  fungus 
have  disappeared,  and  the  lining  membrane  of  the  mouth  seems  quite 
healthy.  For  the  irritation  which  sometimes  appears  round  the  open¬ 
ing  of  the  bowel  great  cleanliness  and  the  application  of  a  little  vaseline 
will  usually  be  sufficient ;  in  some  cases  thorough  dusting  with  a  pow¬ 
der  made  of  equal  parts  of  boracic  acid,  oxide  of  zinc,  and  powdered 
starch  will  be  found  more  rapidly  effective  in  promoting  the  cure.  [The 
Sanitary  Powder  offered  on  page  1230  is  a  suitable  ready-made  article.] 

Diarrhoea. — Infants  nourished  with  artificial  food  are  considerably 
more  prone  to  attacks  of  diarrhoea  than  those  nursed  at  the  breast ;  and 
•as  diarrhoea  is  apt  in  such  children  to  be  not  only  persistent,  but  to 
give  rise  to  further  and  more  serious  results  when  neglected,  early 
attention  should  always  be  given  to  its  cure.  Diarrhoea  may  commence 
simply  with  increased  frequency  of  action  of  the  bowels,  while  the 
motions  remain  of  normal  color  and  consistency.  In  health,  infants 
usually  have  from  two  to  four  actions  of  the  bowels  daily.  When  the 
frequency  of  the  actions  exceeds  this  number,  it  should  be  considered  as 
slightly  abnormal  ;  and  when  there  are  more  than  six  actions  in  the 
twenty-four  hours  some  steps  should  be  taken  to  effect  a  reduction. 
More  commonly  diarrhoea  commences  with  an  alteration  in  the  charac¬ 
ter  of  the  motions,  in  combination  with  increased  frequency.  Instead 


EARLIER  TROUBLES  OF  INFANT  LIFE. 


198 

of  being  yellow  in  color  and  uniform  in  consistency,  the  motions  will 
be  observed  to  be  whitish  or  clay-colored  ;  small  hard  masses  may  be 
noticed  mixed  with  gelatinous  mucus,  or  with  watery  fluid  ;  or  the 
motions  may  consist  mainly  of  masses  of  curdled  milk  covered  with 
mucus  of  a  green  color  and  mucilaginous  consistence.  Not  un- 
frequently  the  infant  will  be  noticed  to  suffer  some  pain  immediately 
before  the  passing  of  the  motions,  and  to  have  apparently  a  sense  of 
relief  for  some  time  after.  Even  when  diarrhoea  commences  with 
actions  of  normal  appearance,  if  it  persists,  the  motions  always  alter  in 
character,  assuming  one  of  the  forms  mentioned  above,  or  becoming 
almost  entirely  watery,  with  a  slight  sediment  of  yellowish  or  brownish 
flakes.  As  diarrhoea  progresses,  the  motions  may  become  much  more 
frequent,  sometimes  occurring  as  often  as  once  every  hour.  After 
persistence  for  two  or  three  days,  irritation  of  the  lower  bowel  is  often 
set  up,  showing  itself  in  a  tendency  to  strain  after  each  motion,  and 
sometimes  in  the  presence  of  a  little  blood  mixed  with  the  mucus  in 
the  motion.  Occasionally  diarrhoea  is  complicated  with  some  sickness  ; 
but  much  vomiting  is  not  common  unless  the  disorder  of  the  digestion, 
from  which  the  diarrhoea  proceeds,  has  progressed  so  far  as  to  set  up  acute 
catarrhal  inflammation  of  the  stomach  and  bowels,  a  condition  of 
things  of  so  serious  a  character  as  invariably  to  call  for  skilled  medical 
assistance. 

The  cause  of  diarrhoea  is  almost  invariably  to  be  found  in  some 
disturbance  of  digestion,  and  the  first  step  to  its  cure  is,  where  possible, 
to  discover  what  the  source  of  its  disturbance  is.  Frequently  this  will 
be  found  to  be  of  a  temporary  and  apparently  trivial  character.  In  the 
case  of  infants  nursed  at  the  breast,  some  slight  indiscretion  of  diet  on 
the  part  of  the  mother  or  wet-nurse,  or  even  some  mental  disturbance 
or  worry,  may  be  sufficient  to  alter  the  lacteal  secretion  to  such  an 
extent  as  to  induce  indigestion  and  diarrhoea.  When  thus  caused, 
diarrhoea  is  usually  of  very  short  duration,  and  passes  off  without  call¬ 
ing  for  any  remedial  measures.  In  artificially  fed  infants  some  change 
in  the  quality  of  the  milk,  due  perhaps  to  its  derivation  from  a  different 
cow,  or  to  some  change  in  the  fodder  of  the  cow  from  which  the  milk 
is  usually  obtained,  may  be  the  disturbing  cause  ;  or  some  slight  de¬ 
composition  of  the  milk,  undetectable  to  ordinary  sense,  but  sufficient 
to  affect  the  sensitive  nerves  controlling  an  infant’s  digestion,  may 
have  taken  place  from  atmospheric  or  other  causes.  As  a  general  rule,  it 
will  be  found  that  the  digestion  of  infants  fed  artificially  is  more  sensi¬ 
tive  and  more  easily  deranged  than  that  of  babies  nourished  on  the 
secretion  of  the  human  breast ;  and  the  disorders  following  derange¬ 
ment  in  such  infants  are  apt  to  be  more  severe  and  of  longer  duration. 
Not  unfrequently  an  attack  of  severe  diarrhoea  is  the  climax  of  impaired 
digestion  which  may  have  existed  for  some  little  time  in  a  modified 


THE  TREATMENT  OF  DIARRHCEA. 


199 


form.  The  artificial  food  of  the  infant  may  for  some  weeks  have  been 
partially  digested  with  perhaps  only  slight  discomfort  and  a  little 
abnormal  appearance  of  the  motions,  and  without  any  apparent  further 
cause  diarrhoea  may  set  in,  and  continue  in  a  troublesome  manner. 
In  many  cases  an  inspection  of  the  motions  of  the  infant  will  throw 
light  on  the  cause  of  the  illness.  If,  in  the  beginning  of  the  diarrhoea, 
hardened  masses  of  curdled  milk  are  found  in  the  motions,  it  may  be 
assumed  that  some  alteration  in  the  milk  supplied  to  the  infant  or  in 
its  preparation  is  the  cause  of  the  disturbance. 

The  treatment  of  diarrhoea  in  infants  should  be  directed,  in  the 
first  place,  to  the  removal  of  any  possible  cause,  and  in  the  second 
place  to  soothing  and  giving  rest  to  the  irritated  stomach  and  bowels. 
When  the  ingestion  of  some  temporarily  affected  food  is  suspected,  it 
is  well  to  commence  the  treatment  by  the  administration  of  a  small 
dose  of  castor-oil,  in  order  to  remove  any  of  the  offending  material 
which  may  still  remain  in  the  bowel.  Usually  about  half  a  teaspoonful 
of  castor-oil  for  an  infant  of  a  few  weeks  old  will  be  sufficient  to  effect 
this ;  if  the  baby  is  three  months  old,  one  teaspoonful  will  form  a 
proper  dose.  After  this  has  been  given,  the  stomach  should  be  allowed 
to  rest  without  any  milk  or  farinaceous  food  for  some  time.  Under 
ordinary  circumstances  infants  will  never  be  found  to  suffer  any  injury 
from  remaining  without  such  foods  for  even  twenty-four  hours 
occasionally  when  the  stomach  is  disordered,  if  some  fluid  nutriment 
be  supplied  at  intervals  in  the  form  of  thin  barley-water,  or  of  diluted 
chicken  or  veal  tea.  Not  unfrequently,  when  diarrhoea  has  been  caused 
by  some  alteration  in  the  quality  of  the  milk,  there  exists  for  one  or 
two  days  afterward  almost  complete  inability  to  digest  even  pure 
diluted  milk,  and  much  the  most  satisfactory  course  to  pursue  is  to 
withhold  it  altogether,  until  the  digestive  power  recovers  itself.  After 
twenty-four  or  forty-eight  hours,  during  which  only  barley-water  or 
chicken-tea  has  been  given,  the  milk  or  farinaceous  food,  more  diluted 
than  usual,  may  be  given  again  in  a  tentative  manner  ;  and  with  care 
the  customary  food  may  be  gradually  resumed.  When  the  disturbance 
is  only  slight,  complete  stoppage  of  the  usual  food  may  not  be  neces¬ 
sary  ;  but  it  will  generally  be  found  advisable  to  increase  its  dilution 
for  some  little  time,  and  to  lengthen  as  far  as  possible  the  intervals  of 
administration,  given  in  the  intervals,  if  the  baby  is  restless  or  thirsty, 
small  quantities  of  thin  barley-water.  When  there  is  evidence  of 
indigestion  having  continued  for  some  little  time  prior  to  the  diarrhoea, 
it  is  proper  to  make  an  alteration  in  the  diet  of  the  child.  Speaking 
generally,  this  change  should  be  in  the  direction  of  some  more  easily 
digested  food  ;  thus,  for  instance,  if  cow’s  milk  diluted  with  water  has 
apparently  not  been  agreeing  with  the  infant,  dilution  with  barley- 
water  may  be  tried,  or  resort  may  be  had  to  humanized  or  to  peptonized 


200 


EARLIER  TROUBLES  OF  INFANT  LIFE. 


milk.  It  must  be  kept  in  view  that  when  diarrhoea  has  once  commenced, 
the  digestive  powers  are  distinctly  diminished  temporarily  ;  and  accord¬ 
ingly  not  only  must  the  food  given  be  more  diluted  than  would  other¬ 
wise  be  necessary,  but  a  longer  interval  must  be  allowed  to  elapse 
between  meals,  as  the  digestive  process  is  slower  as  well  as  more 
feeble.  It  is  unfortunately  the  case  that  infants  suffering  from  diarrhoea 
have  often  an  abnormal  craving  for  food,  and  will  ingest  much  more 
than  even  a  healthy  baby  could  digest ;  in  cases  having  this  character, 
mothers  and  nurses  must  be  careful  not  to  mistake  a  morbid  craving  for 
healthy  appetite.  The  infant  must  be  soothed  as  far  as  possible,  and 
induced  to  wait  during  the  proper  intervals  between  meals,  and  when 
this  cannot  be  managed,  some  innocuous  fluid  must  be  given  in  the 
intervals,  such  as  small  quantities  of  thin  barley  or  rice  water,  or  even 
occasionally  a  small  teaspoonful  of  plain  cold  or  tepid  water. 

As  a  general  rule,  the  less  medicine  given  to  infants  suffering  from 
diarrhoea,  the  more  rapid  their  recovery  will  be  ;  and  no  medicine  at 
all,  with  the  exception  of  one  small  dose  of  castor-oil  at  the  commence¬ 
ment  of  the  illness,  should  be  given  unless  sanctioned  by  medical 
advice.  The  symptoms  which  would  indicate  the  urgent  necessity  of 
skilled  advice  are  mainly  great  frequency  of  the  motions,  the  presence 
of  vomiting,  a  wasted  and  pinched  appearance  of  the  face  of  the  infant, 
tendency  to  coldness  of  the  hands  and  feet,  and  indications  of  twitching 
and  convulsions.  The  appearence  of  any  of  those  symptoms  demands 
immediate  attention. 

[For  all  infantile  bowel  troubles  where  internal  irritations  are  prob¬ 
ably  present,  as  in  diarrhoea,  the  external  use  of  the  Magnetic  Oint, 
ment  is  appropriate,  and  -wonderfully  curative.  Even  in  peritonitis  or 
other  acute  inflammations  where  gentle  rubbings  could  not  be  borue,  it 
may  be  applied,  spread  thickly  on  soft  cloths,  and  if  renewed  three 
times  a  day,  it  will  be  found  a  safe  and  sure  reliance  for  both  children 
and  adults.  For  internal  use  the  Magnetic  Cramp  Tablets  are  a  fine 
remedy  for  children’s  colics,  diarrhoea,  indigestion,  etc.  See  page  1228.] 

Erythema  and  Intertrigo. — The  redness  and  irritation  around 
the  opening  of  the  bowel  which  frequently  results  from  diarrhoea  has 
already  been  described,  and  its  proper  treatment  indicated.  A  similar 
affection  of  the  skin  of  the  thighs,  the  groins,  and  the  front  of  the 
abdomen  not  unfrequently  arises  in  infants  from  some  irritating 
quality  in  the  urinary  secretion.  As  a  result  of  some  form  of  indiges¬ 
tion  in  babies,  the  urine  is  apt  to  become  high-colored  and  of  offensive 
odor.  Urine  of  this  description  seems  to  be  very  irritating  to  the 
delicate  skin  of  the  infant ;  and  unless  the  diapers  are  changed  frequent¬ 
ly,,  and  great  care  in  cleanliness  is  taken,  the  skin  with  -which  the  wet 
diapers  come  in  contact  becomes  inflamed,  reddened,  and  sore-looking, 
developing  a  condition  which  is  technically  known  as  erythema,  or 


SAND  OR  GRAVEL 


201 


when  occurring  chiefly  in  the  folds  of  the  groins,  as  intertrigo.  The 
irritation  often  exists  to  such  an  extent  as  to  cause  exfoliation  of  the 
superficial  layer  of  the  skin,  and  abrasions  result  here  and  there, 
approaching  a  condition  of  slight  ulceration.  Sometimes  in  place  of 
the  general  redness,  an  eruption  of  small  papules  or  pimples  occurs, 
with  normally  colored  skin  intervening  between  the  papules,  the  heads 
of  which  are  often  slightly  flattened  and  abraded.  There  is  usually  no 
difficulty  in  determining  the  nature  of  this  irritation,  and  distinguish¬ 
ing  it  from  other  erythematous  or  papular  eruptions.  Its  limitation  to 
the  part  of  the  skin  covered  by  the  diapers,  and  its  association  with 
disagreeably  smelling  urine,  are  usually  quite  sufficient  to  indicate  its 
character.  To  effect  a.  cure  quickly,  attention  must  be  given  to  the 
diet  of  the  child,  while  at  the  same  time  soothing  applications  are 
made  to  the  inflamed  surface.  It  will  often  be  found  when  intertrigo 
occurs  that  the  diet  of  the  infant  has  been  somewdiat  too  rich  or  too 
abundant,  and  it  will  be  necessary  to  increase  the  dilution  of  the  food, 
or  to  limit  the  quantity.  In  other  cases,  the  condition  of  the  urine, 
together  with  the  appearance  of  the  motions,  will  lead  to  the  conclusion, 
that  the  food  is  being  imperfectly  digested,  and  an  entire  change  of 
diet  may  be  called  for.  The  local  treatment  should  consist  mainly  of 
very  frequent  changing  of  diapers,  great  cleanliness,  and  the  applica¬ 
tion  af  some  soothing  powder  or  ointment.  As  far  as  possible,  the 
diaper  should  be  changed  immediately  the  baby  has  passed  water,  how¬ 
ever  frequently  this  may  occur ;  and  at  least  twice  or  thrice  daily  the 
skin  affected  should  be  bathed  thorough^,  dried  carefully,  and  pow¬ 
dered  well  with  plain  starch-powder,  or  with  a  mixture  of  powdered 
starch  and  oxide  of  zinc.  When  this  is  insufficient  to  effect  a  cure  in  a 
few  days,  it  may  be  necessary  to  apply  some  ointment  in  place  of  the 
powder,  after  the  bathing  and  drying.  The  best  ointment  for  this  is 
one  made  of  equal  parts  of  zinc  ointment  and  Carron-oil  :  this  is  very 
soft  and  cool,  and  forms  a  most  soothing  application  for  the  irritated 
skin.  Nurses  are  rather  prone  to  blame  the  inefficient  washing  of 
diapers  as  the  cause  of  intertrigo  in  infants,  but  it  is  very  doubtful  if 
this  is  ever  the  real  cause  of  the  irritation.  There  is  no  doubt,  how¬ 
ever,  that-it  is  often  induced  by  laxity  in  changing  the  diapers  with 
sufficient  frequency. 

Sand  or  Gravel. — In  close  relation  to  the  condition  of  urine  result¬ 
ing  in  intertrigo  is  that  which  is  characterized  by  the  deposition  of  what 
is  popularly  known  as  “sand”  or  gravel,  and  scientifically  as  uric 
acid.  When  this  affection  of  the  urine  exists  in  infants,  the  sand  is 
observed  as  a  brick-red  or  yellowish-red  deposit  remaining  upon  the 
surface  of  the  diaper,  after  the  urine  has  been  absorbed.  If  the  diaper 
is  dried  carefully,  the  deposit  will  be  noticed  as  a  sandy  powder  which  can 
be  grated  between  the  fingers.  Its  occurrence  is  not  uncommon  in  young 


202 


EARLIER  TROUBLES  OF  INFANT  LIFE. 


infants,  and  unless  persistent,  or  of  very  frequent  recurrence,  is  of  nc 
serious  import.  When  it  is  observed  for  some  days  continuously,  an 
indication  is  given  of  some  disorder  of  digestion,  due  generally  to  a 
somewhat  too  rich  diet,  and  some  little  alteration  must  be  made  to 
obviate  this.  When  infants  are  taking  farinaceous  food,  the  presence 
of  sand  may  indicate  an  insufficiency  of  fluid  diet  and  consequent  con¬ 
centration  of  the  urine,  an  error  easily  rectified  by  increasing  the 
dilution  of  the  food  with  milk  or  water.  The  presence  of  uric  acid  or 
gravel  in  the  urine  of  infants  is  apt  to  give  rise  to  some  pain  in  passing- 
water  ;  and  the  child  will  be  observed  to  refrain  as  long  as  it  possibly 
can  from  doing  so,  and  to  cry  during  the  act  or  immediately  afterward. 

Crying  during  micturition  should  always  excite  suspicion  of 
some  irritating  character  of  the  urine,  and  inspection  of  the  diapers 
will  generally  afford  a  satisfactory  explanation  of  the  discomfort  in¬ 
volved  in  the  act.  If  no  abnormal  appearance  of  the  urine  is  detected, 
the  discomfort  in  micturition  is  usually  due  to  some  slight  irritation  or 
malformation  of  the  external  urinary  organs  of  the  infant,  and  an  ex¬ 
amination  should  be  made  in  order  to  detect  any  abnormality.  In  male 
infants  this  will  sometimes  be  found  in  abnormal  length  or  narrowness 
of  the  foreskin,  a  condition  which  will  call  for  medical  aid,  and  usually 
for  the  slight  operation  of  circumcision.  In  female  infants  abnormal 
conditions  are  not  so  common,  but  occasionally  the  urinary  passage  is 
partially  blocked  by  a  small  membrane  stretching  across  the  opening, 
which  requires  to  be  removed  by  a  slight  incision. 

Constipation,  or  confinement  of  the  bowels,  is  a  not  unfrequent 
trouble  presenting  itself  in  infants,  more  especially  perhaps  in  those 
not  very  robust  at  their  birth.  It  has  already  been  stated  that  usually 
an  infant  passes  three  or  four  motions  in  the  twenty-four  hours.  A 
smaller  number  would  not  be  considered  abnormal  if  the  motions  were 
of  fair  size  and  of  proper  consistency  ;  but  if  only  one  or  two  motions 
are  passed  in  the  twenty-four  hours,  and  these  small  and  somewhat 
hard,  the  condition  would  be  described  as  one  of  slight  constipation  ; 
while,  if  the  child  has  no  action  of  the  bowels  for  one  or  two  days  at  a 
time,  a  degree  of  confinement  exists  which  calls  for  careful  attention 
When  constipation  is  present  to  this  extent,  the  motions  will  usually 
be  found  to  be  very  hard,  and  to  cause  considerable  discomfort,  if  not 
pain,  to  the  baby  in  passing  them  ;  sometimes,  indeed,  the  baby  strains 
so  hard,  and  has  so  much  difficulty  in  passing  the  motion,  that  a  little 
blood  exudes  from  the  edge  of  the  opening  of  the  bowel. 

For  the  immediate  relief  of  constipation  existing  to  the  extent 
described  above,  it  is  usually  desirable  to  administer  an  injection  of 
either  water,  oil,  or  glycerine.  If  the  child  exhibits  a  tendency  to  pass 
the  motion  by  occasional  straining,  it  is  best  to  assist  by  an  injection 
of  one  or  two  ounces  of  olive-oil,  administered  by  means  of  a  pear- 


REMEDIES  FOR  CONSTIPATION. 


203 


shaped  india-rubber  injection  syringe  of  a  size  just  sufficient  to  hold 
the  quantity  indicated,  and  fitted  with  an  ivory  or  vulcanite  nozzle. 
When  there  is  no  tendency  to  natural  action  of  the  bowel,  this  should 
be  stimulated  by  the  injection  of  a  teaspoonful  of  pure  glycerine, 
introduced  by  the  syringe  described  for  the  purpose  in  Chapter  IV.  If 
the  glycerine  injection  does  not  produce  a  proper  action  of  the  bowel 
in  a  quarter  of  an  hour,  a  full  injection  of  warm  water  should  be  given 
with  an  ordinary  family  syringe,  the  injection  being  administered 
slowly,  and  as  much  water  being  used  as  it  is  possible  to  inject.  If 
more  is  injected  than  the  infant  can  accommodate,  it  will  always  re¬ 
turn  at  once  by  the  side  of  the  nozzle,  so  that  no  fear  need  be  enter¬ 
tained  of  causing  injury  by  injecting  too  large  a  quantity.  Fuller 
directions  for  administering  an  enema  of  this  kind  are  given  in  Chapter 
IV.,  p.  33  and  are  equally  applicable  to  infants  as  to  adults. 

General  Rules  for  Prevention  of  Constipation.— After  im¬ 
mediate  relief  lias  been  afforded,  steps  must  be  taken  to  prevent  the 
recurrence  of  the  constipation,  and  to  remove  the  tendency  to  it.  To 
effect  this,  it  is  usually  necessary  to  make  some  alteration  in  the 
infant’s  diet.  Some  foods  are  more  constipating  than  others,  and  a 
change  should  be  made  from  those  to  some  of  a  more  laxative  charac¬ 
ter.  Generally  speaking,  malted  foods  assist  in  maintaining  the  regular 
action  of  the  bowels,  while,  on  the  other  hand,  peptonized  milk  some¬ 
times  produces  a  tendency  to  constipation.  If  the  food  previously 
given  to  the  infant  has  been  digested  satisfactorily,  with  the  exception 
of  the  confinement  of  the  bowels,  it  is  not  usually  desirable  to  give  up 
its  use  altogether ;  the  better  course  is  simply  to  substitute  once  or 
twice  daily  another  food  which  may  assist  in  promoting  the  action  of 
the  bowels.  In  some  cases  where  infants  are  fed  on  diluted  cow’s 
milk,  the  addition  of  a  little  cream  aids  in  preventing  constipation  ;  in 
similar  cases  also  the  administration  of  a  quarter  of  a  teaspoonful  of 
cod -liver  oil  once  or  twice  daily  is  effective  and  advantageous.' 

One  farinaceous  food,  Scotch  oatmeal,  is  often  exceedingly  effec¬ 
tive  in  the  treatment  of  constipation,  and  cannot  unfrequently  be 
digested  by  very  young  infants  if  properly  prepared.  It  is,  however,  a 
somewhat-rich  food,  and  in  some  children  produces  considerable  irrita¬ 
tion  of  the  skin.  Its  employment  in  cases  of  persistent  constipation 
should  always  be  tried,  the  amount  given  being  limited  when  any  signs 
of  irritation  in  the  form  of  “heat-spots”  or  slight  eczema  are  exhibited. 
Oatmeal  is  prepared  in  various  degrees  of  coarseness,  and  sometimes 
one  form  can  be  digested  satisfactorily  when  another  is  unacceptable. 

So  far  as  possible,  the  use  of  laxative  medicines  should  be  avoided 
with  infants.  When  the  constipation  persists  in  spite  of  various 
changes  of  diet,  it  is  best  to  excite  the  action  of  the  bowels,  when 
necessary,  by  injections  of  olive-oil  or  glycerine,  waiting  for  the  time 


204 


EARLIER  TROUBLES  OF  INFANT  LIFE. 


when  the  increasing  age  of  the  baby  will  admit  of  greater  variety  of 
diet. 

[Having  previously  found  occasion  to  mention  the  Magnetic  Oint¬ 
ment  as  a  fine  remedy  for  diarrhoea  and  intestinal  irritations,  it  may 
at  first  sight  seem  curious  to  the  reader  to  find  it  here  also  recommended 
for  relief  of  constipation  ;  but  it  is  no  mistake,  nor  unfounded  claim,  to 
say  that  it  “works  well  both  ways.”  In  using  it  for  constipation  con¬ 
siderable  rubbings  or  deep  manipulations  of  the  bowels  are  necessary, 
and  possibly  these  arc  what  “move  the  bowels,”  but  the  ointment 
certainly  goes  well  with  the  massage  to  prevent  soreness  therefrom  as 
indeed  it  is  an  aid  to  massage  anywhere.] 

Inflammation  of  the  Eyelids  is  a  trouble  not  unfrequent  in 
young  infants,  which  calls  for  much  care  in  order  to  prevent  serious 
ulterior  results.  Its  presence  is  usually  indicated  first  by  the  collection 
of  a  little  watery  matter  at  the  inner  corner  of  the  eye,  which  tends 
to  run  down  the  cheek.  This  is  accompanied,  or  immediately  followed, 
by  some  swelling  of  the  eyelids,  which  are  kept  persistently  shut,  and 
are  reddened  and  discolored  as  well  as  swollen.  If  the  eyelids  are 
separated  with  the  fingers,  the  eyes  are  seen  to  be  injected,  and  more  or 
less  covered  with  the  watery  matter,  which  runs  out  on  the  separation 
of  the  lids.  When  the  inflammation  is  slight,  and  attended  to  at  its 
commencement,  it  usually  subsides  entirely  in  a  few  days.  The  great 
point  in  the  treatment  is  excessive  cleanliness.  The  eyes  must  be 
bathed  carefully  three  or  four  times  a  day,  or  oftener  if  necessary, 
with  clean  warm  water,  or  warm  milk  and  water,  and  care  must  be 
taken  not  to  expose  them  to  a  bright  light.  In  bathing  the  eyes,  it  is 
not  sufficient  to  bathe  merely  the  outside  of  the  lids,  but  the  water,  or 
milk  and  water,  must  be  introduced  within  the  lids,  so  as  to  wash 
thoroughly  the  surface  of  the  eye.  It  is  not  difficult  to  do  this  if  it  is 
done  in  a  proper  manner. 

Application  of  Lotion  to  Infant’s  Eyes.— The  best  method  of 
doing  it  is  here  described,  two  persons  being  required — one  to  hold  the 
baby,  and  the  other  to  apply  the  lotion  properly.  The  one  holds  the 
baby  on  the  knee,  with  its  face  toward  her,  while  the  other  sits  down 
immediately  opposite,  and  in  close  proximity  to  the  first,  having  at  her 
right-hand  side  a  bowl  or  cup  containing  the  lotion,  and  some  small 
pledgets  of  clean  absorbent  cotton  wool,  and,  spread  over  her  knees,  a 
soft  thick  towel.  This  latter  person  separates  a  little  her  knees,  with 
the  towel  lying  upon  them,  while  the  one  holding  the  baby  lowers  its 
head  backward  until  it  rests  on  the  towel,  in  the  hollow  between  the 
knees  of  the  person  sitting  opposite.  The  head  of  the  infant  is  grasped 
gently  but  firmly  between  her  knees,  and  while  the  holder  of  the  baby 
confines  its  hands  and  holds  its  body  firmly,  the  other,  holding  the 
head  between  her  knees,  has  both  her  hands  free  to  apply  the  lotion. 


CLOSED  TEAR  DUCTS. 


205 


With  her  left  hand  she  separates  the  lids  very  gently,  by  pressing  on 
the  bony  projections  above  and  below  the  eye,  while  with  the  right  she 
carefully  bathes  the  eye  with  pledgets  of  wTool  soaked  in  the  lotion. 
The  process  is  very  simple  if  done  by  two  persons  acting  together  in 
this  way,  and  the  only  precaution  necessary  is  that  all  pressure  on  the 
eyes  themselves  should  be  avoided  in  opening  the  eyelids.  If  the  fore¬ 
finger  and  middle-finger  of  the  left  hand  be  used  for  separating  the 
lids,  and  care  taken  that  they  rest  on  the  bony  prominences  well  above 
and  below  the  eye,  no  risk  whatever  to  the  eye  will  ensue,  and  the  lids 
will  be  separated  to  a  sufficient  extent  without  much  difficulty.  Before 
attempting  the  separation,  it  is  always  well  to  dry  the  skin  in  the 
neighborhood  of  the  lids  thoroughly  with  the  towel  on  the  kuees, 
otherwise  the  fingers  are  very  apt  to  slip.  The  cotton-wool  pledgets 
should  be  destroyed  after  use,  as  the  discharge  from  the  inflamed  eyes 
is  contagious  ;  and  the  towel  employed  should  not  be  used  for  any  other 
purpose.  When  a  child  is  suffering  from  inflamed  eyes,  cloths  and 
flannels  used  for  washing  it  should  never  be  employed  for  other  chil¬ 
dren,  and  a  special  towel  should  be  kept  for  its  sole  use,  on  account  of 
the  risk  of  contagion  from  the  discharge.  When  the  discharge  exists 
to  such  an  extent  as  to  require  washing  more  than  three  or  four  times 
a  day  in  order  to  keep  the  eyes  clean,  medical  aid  should  be  had  re¬ 
course  to.  Special  lotions  are  then  necessary,  and  neglect  of  early 
treatment  may  be  followed  by  injuries  to  the  surface  of  the  eye  which 
will  permanently  damage  the  sight. 

Congenital  Closure  of  Lachrymal  Ducts. — A  condition  of  things 
which  may  be  mistaken  for  inflammation  of  the  eyelids  sometimes 
results  from  congenital  closure  of  the  small  canals  at  the  inner  corners 
of  the  eyes  which  normally  fulfil  the  purpose  of  carrying  away  to  the 
nose  the  secretions  from  the  surface  of  the  eyes.  When  these  are  not 
pervious,  the  secretions  collect  like  a  tear  in  the  corner  of  the  eye,  and 
run  down  the  cheek,  not  finding  their  proper  outlet  into  the  nose.  This 
condition  of  matter  does  not,  however,  lead  to  the  swelling  and  dis¬ 
coloration  of  the  eyelids  characteristic  of  inflammation,  but  is  of  course 
much  more  persistent,  as  it  continues  until  by  surgical  means  the  pas¬ 
sage  is  made  clear.  The  earlier  that  this  is  done  the  better  for  the 
child  ;  mothers  should  therefore  lose  no  time  in  drawing  the  attention 
of  their  medical  attendant  to  any  persistent  accumulation  of  fluid  in  the 
corner  of  an  infant’s  eye  or  to  any  continued  tendency  of  tears  to  flow 
down  the  cheeks. 

Vaccination. — [This  is  the  only  subject  of  importance  on  which 
the  editor  of  the  American  Edition  of  this  work  differs  so  much  from 
the  author  as  to  take  exactly  the  opposite  position,  and  the  reader  will 
please  bear  in  mind  that  it  is  Dr.  Foote,  Jr.,  and  not  Dr.  Westland, 
who  pens  what  is  presented  on  this  subject. 


206 


EARLIER  TROUBLES  OF  INFANT  LIFE. 


Dr.  Westland  includes  vaccination  among  the  “  minor  troubles  of 
infancy/’  and  names  it  as  the  one  which  is  imposed  by  English  law,  the 
compulsory  feature  of  which  he  seems  to  approve,  for  he  says  “it  is 
the  duty  of  every  law-abiding  person  to  submit  to  it,”  as  it  was  es¬ 
tablished  only  after  the  fullest  inquiry  into  the  efficacy  of  vaccination  ; 
but,  though  his  revised  edition  is  dated  1898,  the  year  in  which  the 
compulsory  sting  of  the  law  was  taken  out  of  it,  he  says  nothing  of 
this  new  provision  by  which  any  parent  who  has  good  reason  for  dis¬ 
crediting  vaccination  and  who  prefers  to  save  his  infant  from  its  risks, 
may  do  so  by  proclaiming  his  views  before  the  proper  official  and 
obtaining  a  certificate  of  exemption.  This  modification  of  the  English 
law  followed  a  long  investigation  and  report  by  a  “  Royal  Commission  ” 
for  the  investigation  of  vaccination  and  its  disasters,  by  which  it  was 
shown  that  not  only  “  discomforts”  but  serious  illness  and  deaths  wen- 
possible  results  of  all  the  methods  of  vaccination  practised.  The  report 
and  the  last  law  favored  “  glycerinated  calf  lymph”  as  safe  and  free 
from  the  harmful  organisms  which  are  said  to  constitute  the  dangerous 
elements  of  other  forms  of  vaccine  virus.  It  is  worthy  of  remark  here 
that  for  many  years  there  has  been  a  battle  of  the  “lymphs,”  and 
special  claims  were  put  forward  for  the  purity  and  surety  and  safety  of 
various  modes  and  makes  of  vaccine  virus.  The  opponents  of  vaccina¬ 
tion  always  declared  that  they  were  all  bad  in  the  sense  of  being  risky, 
and  the  vaccinators  were  driven  from  one  to  another,  until  they  planted 
their  flag  over  this  last  ditch  of  glycerine  lymph,  from  which  position 
they  are  hurling  as  much  abuse  at  “ivory  points”  as  the  anti-vaccina- 
tors  ever  did.  Now  their  last  hope  is  failing  them,  for  The  Lancet ,  an 
English  medical  magazine  of  authority  among  the  profession,  recently 
appointed  experts  to  examine  all  the  glycerine  vaccine  lymphs  offered 
at  present,  and  they  were  all  found  “  to  swarm  with  extraneous  organ¬ 
isms,”  so  that  The  Lancet  admits  that  “an  absolute  degree  of  purity 
maybe  unattainable,”  and  the  old  war-cry  of  the  opponents  is  justi¬ 
fied — “there  never  was  a  pure  virus  and  cannot  be.”  To  judge  by  the 
claims  of  the  various  makers  of  vaccine  virus  they  have  already  gone 
the  length  of  possibilities  in  adopting  all  practicable  means  of  prevent¬ 
ing  contamination  by  what  are  called  sterilizing  processes,  and  more 
they  cannot  do  !  Dr.  Richard  Slee,  of  Swiftwater,  Fa.  ( in  a  paper 
read  before  the  Associated  Health  Authorities  of  Pennsylvania,  February 
24,  1899),  admits  that  “  the  production  of  vaccine  virus  is  not  an  exact 
science — there  are  many  unsolved  problems.”  He  admits  the  impossi¬ 
bility  of  producing  a  vaccine  free  from  contamination,  but  (before  The 
Lancet's  investigation)  believed  that  the  harmful  germs  die  out  in 
glycerine,  and  that  the  “unpleasant  accompaniments  or  results  of 
vaccination  ”  come  from  after-poisoning  of  the  wound  made  by  vaccina¬ 
ting.  At  one  time  all  vaccinators  were  endeavoring  to  make  light  of 


KEEP  CHILDREN  FREE  FROM  ALL  DISEASES. 


207 


/ 


or  even  deny  the  unexpected  and  undesired  complications,  hut  now  it 
is  only  the  glycerine  lymph  that  they  try  to  protect  from  reproach,  and 
at  last,  when  these  become  too  frequent  and  evident  to  deny,  they 
will  fall  back  on  the  argument  of  Dr.  Joseph  Kbrosi,  of  Budapest, 
quoted  in  Dr.  T.  M.  Rotch’s  “Pediatrics”  (a  recent  standard  medical 
work).  Dr.  Korosi  is  quoted  as  a  most  reliable  statistician,  and  it  seems 
he  has  made  a  study  of  112,000  reported  cases  of  deleterious  effects  of 
vaccination  and  concludes  that  even  if  an  increase  of  deaths  can  be 
charged  to  vaccination,  there  should  be  placed  to  its  credit  a  saving  of 
three  hundred  times  as  many  lives  as  it  costs;  but  “this  is  another 
story  ” — the  question  of  the  utility  of  vaccination — and  it  is  too  long  to 
enter  upon  here.  Suffice  it  to  say  that  more  and  more  members  of  the 
profession  are  getting  their  eyes  open  on  this  subject,- and  coming  to 
accept  the  conclusion  of  Professor  E.  M.  Crookshank,  M.B.,  of  King’s 
College,  London,  who  made  a  thorough  study  of  it  for  himself  and 
then  said  : 

“  Inoculation  of  cow-pox  does  not  have  the  least  effect  in  affording 
immunity  from  the  analogous  disease  in  man,  syphilis  ;  and  neither  do 
cow-pox,  horse-pox,  sheep-pox,  cattle-plague,  or  any  other  radically 
dissimilar  disease,  exercise  any  specific  protective  power  against  human 
small  pox.”  (Yol.  I.,  page  464.) 

All  this  playing  with  poxes  or  “  disease  mongering”  will  be  some 
day  entirely  done  away  with,  and  looked  back  upon  with  shame  by  the 
successors  of  those  who  have  practised  it,  claimed  use  for  it,  and  made 
abundant  excuses  for  the  hundreds  of  thousands  of  disasters  thus 
needlessly  thrust  upon  helpless,  long-suffering  infants. 

Keep  Children  Free  from  all  Diseases. — In  the  “Bulletin  of  the 
State  Board  of  Health  of  Tennessee  ”  was  once  published  an  article 
making  a  strong  protest  against  the  prevalent  and  false  idea  “that  it  is 
better  for  children,  while  young,  to  have  such  diseases  as  mumps, 
measles,  scarlet  fever,  and  be  over  with  them.”  Among  the  more 
ignorant  classes  there  exists  the  practice  of  deliberately  exposing  their 
little  ones  to  all  such  diseases  as  they  come  around,  but  the  Bulletin 
truly  says  that  they  are  all  liable  to  be  followed  by  serious  conse¬ 
quences,  even  death,  and  therefore,  “under  the  teachings  of  modern 
preventive  medicine  to  do  such  an  act  is  hut  to  perpetrate  upon  the  help¬ 
less  child  the  grossest  wrong.  The  only  just  and  intelligent  rule  under 
any  and  all  circumstances  is  ‘ keep  children  from  all  children's 
diseases'  These  are  the  words  of  one  of  our  most  distinguished  writers 
upon  children’s  diseases,  and  they  constitute  the  working  rule  of  every 
health  officer  in  the  land.”  Would  this  were  true  instead  of  false! 
Vaccinia  is  a  child’s  disease,  and  officials  diligently  spread  it,  repeatedly 
and  compulsorily,  in  spite  of  severe  complications  and  some  uncertain 
proportion  of  deaths,  Will  they  never  get  their  eyes  open  to  the  gross 


208 


EARLIER  TROUBLES  OF  INFANT  LIFE. 


Inconsistency  between  their  preaching  and  practising  ?  How  can  they 
dispel  a  “popular  fallacy”  while  pushing  their  own  medical  fallacy  ? 
The  only  consistent  sanitarians  are  the  anti-vaccinators.  They  have 
a  never-failing  preference  to  keep  clean  and  healthy  ;  they  worship  at 
the  shrine  of  Hygeia  and  decline  to  bow  down  to  the  beast  of  vaccina¬ 
tion.  There  are  level-headed  doctors  among  them,  of  all  schools,  and 
men  of  all  professions  who  think  in  line  with  modern  sense  and  true 
sanitation.  There  are  hundreds  of  “common  people”  who  have  been 
hurt  by  vaccination,  and  have  sense  enough  to  know  it,  and  are  not  be¬ 
fuddled  by  the  obfuscating  doctors  who  would  make  them  believe  that 
its  nice  to  be  sick,  that  clean  health  is  to  be  had  by  promoting  filth 
disease.  They  are,  however,  yet  willing  to  let  those  that  leant  it  have 
it,  and  all  they  want  of  it,  but  the  more  its  advocates  urge  its  protective 
powers,  the  more  the  protestants  protest  that  there  is  no  need  to  enforce 
it  on  them  and  theirs — they  merely  say  “excuse  us.” 

We  wish  to  say  to  the  many  well-meaning  doctors  who  take  part 
in  the  tacit  conspiracy  to  “ preserve  vaccination  from  reproach,”  stop 
and  think  and,  for  a  moment,  admit  that  vaccination  can  serve  no 
useful  purpose,  that  its  supposed  “beautiful  beneficence”  is  all  a 
delusion,  that  you  have  been  misled  by  the  power  of  precedent  and 
authority,  and  that  creditable,  cleanly,  welcome  sanitary  precautions 
are  after  all  the  true  and  only  effective  prophylactic  against  small-pox  ; 
then  consider  the  days  and  nights  of  pain  and  suffering,  even  the. 
thousands  of  years  in  the  aggregate,  that  vaccination  has  inflicted  on 
the  human  race,  the  numerous  cases  of  life-long  chronic  ailments  that 
have  been  traced  to  its  influence,  and  the  unknown  number  of  fatalities 
(about  one  a  week  acknowledged  and  recorded  in  England  for  ten 
years);  figure  up  the  account  against  vaccination,  and  if,  as  we  are 
fully  convinced,  there  is  nothing  to  be  gained  by  it,  what  can  the  medi¬ 
cal  profession  do  for  mankind  to  atone  for  one  hundred  years  of  foster¬ 
ing  this  greatest  of  all  medical  delusions,  what  can  it  say  in  extenua¬ 
tion  of  the  evil  done  through  this,  its  most  fearful  error,  and  what 
excuse  can  it  now  offer  for  “going  it  blind,”  refusing  to  study 
and  investigate,  and  absolutely  persisting  in  coercing  the  people  to 
continue  a  practice  positively  proven  to  be  attended  with  great  risks 
and  frequent  fatalities  ?  If  you  are  in  error  the  score  against  you  is  a 
fearful  one,  but  delaying  confession  can  only  make  it  worse. 

This  book  was  written  to  mitigate  the  troubles  of  infant  life,  and 
the  writer  of  this  interpolation  does  not  consider  it  the  function  of  a 
physician  to  add  to  them  in  any  way.  The  indictment  against  vaccina¬ 
tion  is  not  based  merely  on  the  unusual  ulcers  and  prolonged  sore  arms, 
and  wasting  fevers  of  erysipelas  and  pyaemia  (blood-poisoning)  which 
may  result  from  it,  or  even  the  cases  that  soon  end  fatally  ;  the  latter 
might  be  envied  by  the  miserable  children  blighted  for  life,  crippled. 


HEALTH  THE  BEST  RELIANCE. 


209 


distorted,  and  damaged  beyond  repair  by  the  ravages  of  disease  directly 
due  to  vaccination  (possibly,  no  doubt,  in  some  cases  because  imposed 
on  a  weakly  constitution).  Besides  these  aggravated  instances  of 
visible  ruin  of  which  there  are  living  specimens  as  well  as  photographs 
to  exhibit,  we  must  not  forget  the  thousands  of  cases  of  moderate 
chronic  ill-health  from  long  lingering  impairment  of  the  blood  and 
disorder  of  vital  processes  dating  back  to  vaccination. 

It  is  the  physician’s  function  to  prevent  and  relieve  disease,  not  to 
inflict  it,  nor  even  to  impose  a  slight  one  in  expectation  of  warding  off 
another  that  would  probably  never  come  ;  and  so  far  as  the  writer  of 
this  is  concerned  in  the  production  of  a  book  for  the  people,  instruct¬ 
ing  them  in  the  care  of  their  young,  he  feels  it  his  duty  to  urge  them 
by  all  possible  means  to  work  for  the  maintenance  of  health  and  the 
avoidance  of  all  disease,  believing  with  Virchow,  the  greatest  German 
pathologist,  in  his  latest  expression  of  opinion  on  this  subject,  that 
health  is  the  most  sure  protection  against  “disease  germs’’  or  the 
pernicious  microbes  that  are  found  to  be  attendant  in  a  great  variety 
of  diseased  conditions.  Do  all  you  can  to  keep  your  child’s  blood  clean 
and  pure,  and  nothing  to  contaminate  or  deprave  it.  This  is  the  true 
religion  of  hygiene;  vaccination  is  “playing  the  devil,”  and  often 
“there  is  the  devil  to  pay.” 

Dr.  Westland  devotes  two  or  three  pages  to  describing  the  “nor¬ 
mal  progress  of  vaccination,”  and  what  to  do  for  the  minor  complica¬ 
tions,  but  this  space  has  been  devoted  (as  I  think)  to  better  use,  and  it 
only  remains  to  say  that  if  a  parent  yields  his  child  to  vaccination,  he 
should  hold  the  operator  responsible  for  results.  Do  just  as  the  physi¬ 
cian  advises,  as  to  care  of  the  wound,  and  all  after-treatment,  so  that 
it  may  not  be  possible  for  him  to  lay  the  blame  upon  you  if  any  sort  of 
complication  results  ;  and  require  him  to  keep  the  child  under  observa¬ 
tion  so  that  he  cannot  escape  responsibility  by  saying  “you  didn’t  call 
my  attention  to  this  in  time.”  It  is  a  far  too  common  practice  for 
physicians  to  vaccinate  from  a  dozen  to  one  hundred  or  more  infants  a 
day  and  then  leave  the  results  to  fate  and  the  lack  of  care  of  parents 
who  have  enough  other  troubles  on  their  hands. — E.  B.  Foote,  Jr.] 


CHAPTER  XVIII 


Some  Disorders  Associated  with  the  Process  op  Dentition. 

Condition  of  Nervous  System  during  Dentition;  Difference  of  Manifestations 
in  First  and  Second  Dentitions;  Affections  of  Gums  and  Mouth;  Ulcers  of 
Mouth;  Distinction  from  Thrush;  Feverish  Attacks;  Restlessness  at  Night; 
Disorders  of  Digestion;  Treatment;  Colic  and  Diarrhoea;  Cold  and  Cough; 
False  Croup;  Bronchial  Catarrh;  Necessity  of  Care;  Treatment  of  Cold, 
of  False  Croup,  of  Bronchitis;  Child-crowing,  Treatment;  Genei’al  Con¬ 
vulsions,  Treatment;  Abscess  of  Ear;  Treatment;  Night  Terrors;  Other 
Mental  Peculiarities. 

Condition  of  Nervous  System  during  Dentition.— During  the 

two  periods  of  dentition,  both  when  the  child  is  cutting  the  first  set  of 
teeth,  between  the  ages  usually  of  six  months  and  two  years,  and  when 
developing  the  second  set  .between  six  and  thirteen  years  of  age, 
various  disturbances  of  health  are  apt  to  present  themselves.  While 
dentition  is  proceeding  the  nervous  system  of  children  appears  to  be¬ 
come  very  irritable  ;  and  as  a  result,  slight  causes  of  disturbance,  which 
in  general  would  scarcely  produce  any  visible  effect,  are  apt  to  be 
followed  during  teething  by  consequences  apparently  out  of  all  propor¬ 
tion  to  their  influence.  In  this  condition  a  very  slight  chill  may  be  the 
exciting  cause  of  severe  bronchitis,  while  the  ingestion  of  some  not 
very  easily  digested  food  may  result  in  violent  diarrhoea  or  even  acute 
inflammation  of  the  bowels.  A  special  feature  of  this  period  of  life  is 
the  facility  with  which  considerable  fever  with  much  increased  tempera¬ 
ture  is  induced,  a  condition  in  itself  tending  to  increase  still  further  the 
already  excitable  state  of  the  nervous  system.  While  it  cannot  be  said 
that  any  of  the  illnesses  to  be  described  in  this  chapter  are  exclusively 
associated  with  the  eruption  of  the  teeth,  they  yet  occur  so  frequently 
during  these  periods,  and  when  they  occur  manifest  so  apparently 
some  relation  to  the  dental  development,  that  it  is  most  convenient  to 
describe  them  here.  Some  of  them  are  evidently  the  direct  result  of 
the  passage  of  the  teeth  through  the  gums  ;  others,  more  especially  the 
disorders  affecting  the  nervous  system,  belong  to  a  class  known  in 
medicine  as  “  reflex  nervous  phenomena, ”  an  expression  which  means 
here  that  the  irritation  of  the  nerves  of  the  gums,  produced  by  the 
pressure;  of  the  advancing  teeth,  is  prone  to  relieve  itself  by  some  mani* 


IRRITATION  OF  THE  GUMS. 


21 1 


festation  of  irregular  nervous  discharge  in  some  other  part  of  the  body, 
giving  rise,  it  may  be,  to  muscular  spasms  or  convulsions.  The  dis¬ 
turbances  of  health  due  to  teething  occur  with  much  more  frequency 
and  greater  severity  during  the  first  than  during  the  second  dentition, 
and  the  specific  descriptions  which  follow  apply  only  to  the  earlier 
process,  which  takes  place  usually  between  the  ages  of  six  months  and 
two  years,  unless  where  it  is  specially  stated  that  the  second  dentition 
is  referred  to.  It  is  to  be  understood  that  the  second  dentition  is 
occasionally  characterized  by  similar  affections,  which  however  at  that 
period  rarely  present  themselves  in  the  acute  form  in  which  they 
appear  during  the  eruption  of  the  first  or  milk  teeth.  In  the  first  place 
will  be  described  the  affections  of  the  gums  and  mouth  which  result 
directly  from  the  eruption  of  the  teeth  through  the  tissues  which  cover 
and  conceal  them  for  some  months  after  birth. 

Affections  of  Gums  and  Mouth.  —Generally,  for  some  weeks  or 
even  for  two  or  three  months  before  any  teeth  make  their  way  through 
the  gums,  their  appearance  is  foreshadowed  by  slight  irritation  of  the 
gums,  accompanied  by  an  excessive  secretion  of  saliva,  which  flows 
occasionally  from  the  mouth  of  the  child,  an  occurrence  generally 
known  as  “dribbling.”  This  is  usually  associated  with  some  slight 
irritability  of  temper,  shown  by  a  tendency  to  cry  on  slight  provoca¬ 
tion  ;  and  is  apparently  relieved  by  rubbing  and  pressure,  as  the  infant 
will  be  observed  to  bite  its  own  fingers  or  any  other  substance  conven¬ 
ient,  and  to  derive  comfort  from  doing  so.  It  will  usually  be  noticed 
also  that  the  child  when  fretful  can  be  soothed  by  its  mother  or  nurse 
gently  rubbing  its  gums  with  her  finger.  If  the  gums  are  examined 
during  this  period,  they  will  be  found  to  be  somewhat  swollen  and  of 
a  rather  brighter  red  color  than  normal.  Immediately  before  a  tooth 
comes  through,  the  gum  covering  it  will  often  be  seen  to  be  very  tense 
and  swollen,  and  at  this  stage  may  sometimes  be  so  tender  that  the 
child  resents  any  attempt  to  touch  it.  This  swelling  and  tenderness 
subside  directly  the  tooth  has  made  its  way  through  the  gum,  and  a 
period  of  comparative  comfort  ensues  until  another  tooth  arrives  at  the 
same  stage.  The  amount  of  discomfort  suffered  varies  very  much  with 
different  infants.  Some  cut  all  their  teeth  with  practically  no  discom¬ 
fort,  while  others  suffer  pain  and  become  irritable  during  the  eruption 
of  every  individual  tooth.  In  this  respect  it  seems  to  matter  little 
■whether  the  teeth  are  cut  comparatively  early  or  late.  As  a  rule,  the 
double  teeth  and  the  canines  give  rise  to  more  discomfort  than  the 
incisors,  but  this  is  a  rule  not  by  any  means  without  many  exceptions. 
In  addition  to  the  irritation  of  the  gums  so  frequently  present,  some 
inflammation  of  the  rest  of  the  mouth  is  not  very  uncommon  ;  and  this 
sometimes  exists  to  such  an  extent  as  to  aive  rise  to  small  ulcers,  which 
are  occasionally  seen  not  only  on  the  tongue,  but  also  on  the  inside  of 


212 


DISORDERS  WITH  PROCESS  OF  DENTITION. 


the  lips  and  cheeks.  They  are  readily  distinguished  from  the  little 
ulcers  which  occur  during  thrush,  by  the  absence  of  any  appearance  of 
the  white  fungus  growth  characteristic  of  that  disease  ;  moreover, 
thrush  is  very  seldom  observed  in  children  in  fair  health  after  the  age 
of  six  months.  The  inflammation  and  irritation  of  the  gums  and 
mouth  very  seldom  exist  to  such  an  extent  as  to  interfere  materially 
with  the  infant  taking  food  ;  not  unfrequently  indeed  an  increased 
desire  for  food  is  observed,  the  contact  with  the  nipple  of  the  bottle  or 
with  the  feeding-spoon  apparently  giving  a  sense  of  relief,  while  the 
food  has  a  soothing  effect  upon  the  inflamed  surface. 

The  irritation  of  the  gums  resulting  from  teething  is  geneially 
associated  with  irregular  feverish  attacks,  characterized  by  abnormally 
high  and  capriciously  varying  temperatures.  If  the  temperature  of  the 
child  be  taken  occasionally  with  the  clinical  thermometer,  a  temporary 
rise  of  temperature  of  three  or  four  or  even  more  degrees  will  not  un¬ 
frequently  be  noticed  ;  and  if  careful  observations  are  made  the  altera¬ 
tions  in  temperature  will  be  found  frequent  and  erratic. 

Resulting  from  this  in  some  measure  is  the  restlessness  at  night 
which  is  often  remarked.  The  child  wakens  suddenly  in  its  sleep  and 
cries  out,  or  is  restless  and  disturbed,  kicking  with  its  legs  and  moving 
its  arms  frequently.  As  a  secondary  result  of  the  feverishness,  dis¬ 
orders  of  digestion  are  prone  to  occur,  assuming  generally  the  form 
of  diarrhoea  with  colicky  pains  giving  rise  to  occasional  attacks  of  loud 
crying,  sometimes  of  vomiting  and  intolerance  of  the  food  which  pre¬ 
viously  had  been  satisfactorily  assimilated. 

Treatment  of  Affections  of  the  Mouth. — These  various  troubles 
are  susceptible  of  much  alleviation  by  the  employment  of  remedies,  some 
local  and  some  general.  For  the  dribbling  alone  no  treatment  is  neces- 
sary,  but  when  the  irritable  condition  of  the  gums  is  troublesome,  it  is 
well  to  rub  them  once  or  twice  daily  with  some  slight  astringent  such 
as  glycerine  of  borax.  This  should  be  applied  gently  with  the  finger 
of  the  mother  or  nurse.  Gentle  friction  with  fresh  lemon-juice  is  also 
frequently  of  much  value  in  soothing  the  discomfort.  At  the  same 
time  the  occasional  use  of  some  mild  laxative  medicine  is  advisable, 
half  a  teaspoonful  of  castor-oil,  or  a  teaspoonful  of  sweet  essence  of 
senna,  being  an  eligible  dose  for  a  child  of  one  year.  When  similar  dis¬ 
comforts  arise  during  the  second  dentition  mild  saline  purgatives,  such 
as  effervescing  citrate  of  magnesia,  are  of  much  value,  and  are  best 
administered  in  the  morning  before  breakfast.  When  a  tooth  is  ob¬ 
served  actually  projecting  under  the  swollen  and  tender  gum,  lancing 
with  a  sharp  and  clean  lancet  will  generally  afford  immediate  relief, 
and  complete  the  eruption  through  the  gum.  For  the  treatment  of  the 
small  ulcers  on  the  mouth  described  above,  nothing  is  better  than  the 
application  two  or  three  times  daily  of  glycerine  of  borax  ;  their  cure 


COLIC,  DIARRIICEA,  COLDS  AND  COUGHS. 


213 


is  hastened  also  by  the  administration  internally  of  a  little  chlorate  of 
potash,  one  grain  of  which  to  each  year  of  the  child’s  age  may  be  given 
three  times  daily.  The  feverish  attacks  are  generally  relieved  most 
quickly  by  the  administration  of  laxatives,  among  the  most  eligible  of 
which  are  sweet  essence  of  senna  or  compound  licorice  powder. 
Combined  with  this  laxative  treatment,  the  employment  of  tepid  baths 
night  and  morning  is  often  very  beneficial.  The  water  in  the  bath 
should  have  a  temperature  of  about  90°  F.,  and  the  child  should  re¬ 
main  in  it  five  or  ten  minutes.  A  bath  at  this  temperature,  given  just 
before  bed-time,  is  often  of  much  value  in  inducing  and  maintaining 
quiet  sleep. 

Treatment  of  Colic  and  Diarrhoea. — When  there  is  any  tendency 
to  these  disorders,  great  care  in  diet  must  be  taken,  and  the  stomach 
and  abdomen  of  the  child  must  be  clothed  very  warmly.  The  only 
laxative  medicine  permissible  under  such  circumstances  is  castor-oil,  and 
this  should  only  be  given  early  in  the  attack.  When  the  diarrhoea 
persists,  it  may  be  necessary  sometimes  to  stop  for  a  day  or  two  the 
administration  of  farinaceous  foods,  and  to  feed  the  child  exclusively 
on  animal  broths,  such  as  cliicken-tea,  veal-tea,  or  beef-tea,  together 
with  some  milk  diluted  with  barley  or  lime  water.  In  older  children 
during  die  second  dentition  diarrhoea  is  rarely  troublesome,  and  is 
usually  cured  quickly  by  one  or  two  teaspoonfuls  of  castor-oil  taken  at 
the  commencement  of  the  illness,  and  followed  by  abstinence  for  a  day 
or  two  from  all  foods  likely  to  irritate.  It  is  desirable  to  emphasize  the 
importance  of  temporary  abstinence  from  food  in  all  cases  of  acute 
irritation  of  the  digestive  canal  ;  children  in  ordinary  health  never 
suffer  from  even  complete  starvation  for  twenty-four  hours,  if  any 
thirst  is  allayed  by  water  or  other  innocuous  fluid. 

Cold  and  Cough. — The  disturbance  resulting  from  dentition  fre¬ 
quently  manifests  itself  in  slight  inflammation  of  the  lining  membrane 
of  the  nose,  the  windpipe,  and  the  bronchial  tubes,  giving  rise  to  cold 
in  the  head,  and  to  attacks  of  cough  varying  in  character  according  to 
the  part  of  the  windpipe  and  bronchial  tubes  affected.  In  most  cases 
where  actual  false  croup  or  bronchitis  occurs  during  teething,  it  is 
probable  that  some  temporary  exposure  to  cold  has  combined  with  the 
irritation  of  teething  to  cause  the  illness  ;  but  the  susceptibility  to  this 
form  of  disease  is  so  strong  in  many  children  at  this  period  of  their 
Jives,  that  the  most  careful  attention  to  warmth  is  not  invariably 
successful  in  preventing  the  attacks,  although  doubtless  of  much  value 
in  mitigating  their  severity. 

The  colds,  as  they  are  popularly  termed,  usually  commence  with 
difficulty  in  breathing  through  the  nose,  accompanied  by  some  watery 
or  mucous  discharge,  and  a  tendency  of  the  eyes  to  water.  There  is 
generally  also  slight  fever,  and  restlessness  at  night,  often,  at  least  in 


214 


DISORDERS  WITH  PROCESS  OF  DENTITION. 


young  children,  due  more  to  the  difficulty  in  breathing  through  the' 
nose,  than  to  the  discomfort  resulting  from  the  fever.  Within  a  day 
or  two  a  hoarse  croupy  cough  develops,  associated  with  some  hoarse¬ 
ness  of  the  voice,  and  occasionally  actual  discomfort  in  speaking. 

False  Croup. — It  is  at  this  stage  that  the  apparently  alarming 
but  not  really  very  serious  attacks  of  so-called  false  croup  are  apt  to 
occur  during  the  night.  Children  vary  very  much  iu  their  suscepti¬ 
bility  to  such  attacks,  some  never  suffering  from  them  however  fre¬ 
quently  they  may  take  cold,  while  others  seldom  pass  through  a  cold 
without  experiencing  one  or  more  attacks.  The  child  has  perhaps  been 
fairly  well  all  day,  with  only  a  slight  cold  in  its  head,  and  possibly  a 
little  hoarseness  of  the  voice  with  slight  cough.  Within  one  or  two 
hours  after  falling  asleep  it  wakens  apparently  choking,  with  loud 
ringing  cough,  and  great  difficulty  in  drawing  in  its  breath.  It  usually 
starts  up  in  bed,  grasps  the  side  of  the  bed  and  anything  else  within 
reach,  and  struggles  for  breath  for  perhaps  a  few  minutes,  coughing 
in  a  characteristic  manner  very  frequently,  and  drawing  in  its  breath 
often  with  a  sound  like  the  “whoop”  of  whooping-cough.  This  con¬ 
dition  seldom  lasts  in  an  acute  form  for  more  than  a  few  minutes  ;  but 
for  some  little  time  afterward  slight  difficulty  in  inspiration  is  often 
present,  and  young  children  are  usually  much  frightened  and  cry  for 
some  time  after  the  attack.  In  the  course  of  perhaps  twenty  minutes 
or  half  an  hour  all  traces  of  the  attack  may  have  disappeared,  and  the 
child  will  again  sleep  peacefully  as  before. 

Bronchial  Catarrh. — A  day  or  two  later  in  the  course  of  the  cold 
the  cough  generally  alters  in  character,  becoming  the  cough  of  ordinary 
bronchitis,  and  the  hoarseness  disappears  ;  slight  wheezing  sounds  may 
be  heard  if  the  ear  is  applied  to  the  chest  of  the  child,  and  perhaps 
some  little  increased  quickness  of  breathing,  due  to  the  bronchial  tubes 
being  partially  obstructed  by  mucus.  Children  of  five  years  old  and 
upward  will  usually  cough  up  and  expectorate  some  of  this  mucus, 
which  is  generally  of  a  wThitish  gelatinous  character,  tending  to  become 
more  yellow  and  less  thick  as  the  illness  progresses  ;  younger  children 
almost  invariably  swallow  it  after  bringing  it  up  into  the  throat,  and, 
as  a  result  of  its  entry  into  the  stomach,  some  temporary  indigestion  is 
usually  set  up  in  addition  to  the  bronchial  irritation.  If  good  care  be 
taken  of  the  child  at  this  period,  the  cough  usually  becomes  softer  and 
less  frequent,  and  recovery  quickly  ensues.  What  has  been  described 
here  is  the  course  of  an  ordinary  cold  affecting  a  child  during  dentition. 
In  children  prone  to  bronchitis,  or  subjected  to  severe  exposure  to 
cold,  the  inflammation  attacking  the  windpipe  and  that  affecting  the 
bronchial  tubes  may  be  very  much  more  acute  ;  but  these  severe  at¬ 
tacks  of  laryngitis  and  bronchitis,  as  they  are  severally  termed,  fall 
to  be  referred  to  rather  under  the  heading  of  the  Common  Maladies 


TREATMENT  OF  COLDS. 


215 

of  Children,  than  in  a  chapter  devoted  to  the  disorders  connected  with 
dentition. 

Necessity  of  Care  during  Dentition.— From  the  description 

given  above,  it  should  be  obvious  that  even  slight  colds,  affecting  the 
head  only,  should  never  be  neglected  in  children  at  the  period  of  teeth¬ 
ing.  The  earlier  care  is  taken,  the  more  probable  it  is  that  the  cold 
will  be  cut  short  and  prevented  from  running  through  its  various 
stages  ;  and  even  if  this  is  not  effected,  early  care  will  go  far  to 
diminish  and  render  unimportant  the  later  developments. 

Treatment  of  Cold. — If  the  weather  be  at  all  cold,  the  child 
should  be  confined  to  one  room  properly  heated  and  ventilated,  and 
care  should  be  taken  to  maintain  the  temperature  of  the  room  through¬ 
out  the  night.  There'  is-  no  doubt  that  many  of  the  attacks  of  false 
croup  are  brought  on  by  lowering  of  the  temperature  of  the  room  in 
which  the  child  sleeps  at  night.  Ordinarily  a  child  breathes  entirely 
through  its  nose,  and  the  air  is  warmed  and  rendered  moist  before  it 
reaches  the  windpipe  by  contact  with  the  internal  surface  of  the  nose. 
When  the  nose  is  closed  by  cold,  the  child  is  compelled  to  breathe 
through  the  mouth,  and  the  cold  air  enters  directly,  with  very  little 
previous  heating,  into  the  windpipe,  the  very  sensitive  surface  of  which 
is  irritated  and  dried.  Some  spasm  of  the  vocal  cords  at  the  entrance 
of  the  windpipe  is  excited  by  this  irritation,  and  this  spasm,  along  with 
the  cough  resulting  from  the  same  causes,  constitutes  essentially  the 
attack  described  above  as  false  croup. 

In  addition  to  keeping  the  room  warm  at  night,  it  is  of  importance 
to  maintain  the  warmth  of  the  hands  and  feet  of  the  child.  It  should 
be  clothed  in  a  flannel  night-dress,  and  a  bottle  filled  with  warm  water 
and  covered  with  flannel  should  be  placed  near  its  feet.  A  warm  bath 
given  just  before  placing  the  child  in  bed,  the  water  being  of  the  tem¬ 
perature  of  100°  F.,  is  often  of  much  value  in  promoting  perspiration 
and  thus  relieving  the  fulness  of  the  head  ;  and  this  is  assisted  also  by 
the  administration  of  some  warm  drink,  such  as  gruel  or  an  infusion  of 
jam  in  hot  water,  before  the  child  goes  to  asleep.  When  any  hoarse¬ 
ness  or  cough  appears,  some  stimulating  liniment  [no  liniment  is  equal 
for  this  purpose  to  the  Magnetic  Ointment]  should  be  rubbed  well 
into  the  chest  and  back  night  and  morning  ;  or,  especially  if  the  child 
is  feverish  and  restless,  a  weak  mustard-poultice,  made  of  one-fifth  or 
one-fourth  part  of  mustard  to  four  fifths  or  three-fourths  of  linseed, 
should  be  applied  to  the  chest  for  one  or  two  hours,  and  on  its  removal 
should  be  replaced  by  cotton-wool.  Mustard-poultices  well  made  are  very 
soothing,  even  when  they  irritate  the  skin  slightly,  and  often  promote 
sleep.  When  a  child  falls  asleep  with  one  on  its  chest,  care  must  be 
taken  to  remove  it  at  the  proper  time,  otherwise  more  irritation  of  the 
skin  than  was  intended  may  result. 


2 1 6  DISORDERS  WITH  PROCESS  OF  DENTITION. 


When' the  cough  is  frequent  and  troublesome,  much  relief  is  often 
given  by  the  administration  of  a  few  drops  of  ipecacuanha  wine  in  a 
teaspoonful  of  glycerine  every  two  hours.  Children  are  very  tolerant 
of  this  drug,  and  will  take  it  in  almost  as  large  doses  as  adults.  To  a 
child  of  one  year  old,  five  drops  may  safely  be  given  every  two  hours, 
while  a  child  of  five  will  take  ten  drops  without  experiencing  any 
nausea  or  other  discomfort. 

Treatment  of  False  Croup. — For  the  spasmodic  attacks  w  hich 
occasionally  occur  at  night.,  the  best  treatment  is  immersion  in  a  warm 
bath  of  98°  F.,  accompanied  by  an  emetic  iu  the  form  of  one  or  two 
teaspoonfuls  of  ipecacuanha  wine.  The  ipecacuanha  should  be  given 
as  soon  as  the  child  can  be  induced  to  swallow  it ;  and  if  vomiting  does 
not  result  in  a  few  minutes,  it  should  be  induced  by  introducing  the 
finger  into  the  mouth  and  tickling  the  back  of  the  throat.  If  enough 
w’arm  water  for  a  bath  is  not  readily  available,  the  application  of  a 
sponge  wrung  out  of  wrarm  water  to  the  outside  of  the  throat,  just 
under  the  chin,  is  often  an  efficacious  remedy.  The  tendency  to 
spasmodic  attacks  of  this  kind  is  much  diminished  by  saturating  the 
atmosphere  of  the  room  with  steam  from  a  steam-kettle.  Attention  to 
the  regular  action  of  the  bowels  is  also  important  as  a  preventive,  and 
it  is  usually  desirable  to  administer  a  dose  of  castor  oil  in  the  morning 
after  an  attack  has  been  experienced. 

[All  the  afore-mentioned  expedients  and  even  more  are  worth 
while  to  ward  off  these  attacks,  so  distressing  to  infant  and  parents — 
sometimes  almost  frightfully  so.  Some  infants  have  a  constitutional 
(scrofulous)  tendency  which  renders  them  unusually  prone  to  them  ; 
but  whatever  the  causes,  if  they  are  counteracted  or  attended  to  so  far  as 
possible,  there  is  a  preventive  wdiich  has  proved  its  power  to  ward  off 
these  acute  spasms.  It  is  the  Magnetic  Croup  Tippet,  which  if  placed 
about  the  child’s  neck  at  bed-time,  and  so  worn  steadily  during  crou- 
py  seasons,  protects  croupy  children  effectually  from  such  spasmodic 
attacks.  See  page  1227.] 

Treatment  of  Bronchitis. — When  bronchitis  occurs,  treatment 
similar  to  that  employed  wdien  the  wind  pipe  is  affected  should  be  con¬ 
tinued.  Five  to  ten  drops  of  ipecacuanha  wine  in  a  teaspoonful  of 
glycerine  should  be  given  every  three  hours,  and  the  chest  and  back 
should  be  well  rubbed  twice  daily  with  some  stimulating  liniment.  If 
the  cough  is  severe,  or  the  breathing  at  all  impeded,  diluted  mustard- 
poultices  should  be  applied  occasionally  to  the  chest  ;  and  in  the  inter¬ 
vals  between  their  application  cotton-wmol  should  be  employed  to  cover 
the  chest,  the  skin  being  rubbed  gently  with  olive-oil  or  vaseline  if 
much  reddened  by  the  poultices.  The  temperature  of  the  room  in 
wThich  the  child  is  confined  should  not  be  allowed  to  fall  below  64°  F., 
and  especial  care  should  be  taken  to  maintain  this  temperature  through- 


CHILD  CROWING. 


217 


out  the  night.  The  use  of  a  steam-kettle  is  of  much  value  in  soothing 
a  troublesome  cough.  For  heating  rooms  in  which  children  are  con¬ 
fined  suffering  from  cold  or  bronchitis,  open  fires  are  much  preferable 
to  gas  stoves,  which  by  drying  the  atmosphere  occasionally  add  to  the 
irritation  of  the  lining  membrane  of  the  nose  and  throat.  The  injuri¬ 
ous  effect  of  gas  stoves  can  be  modified  by  the  evaporation  of  water  in 
their  vacinity,  but  under  no  circumstances  are  they  comparable  in 
value  to  open  fires. 

Child-Crowing  . — The  spasmodic  attacks  of  false  croup  which 
have  been  already  described  have  to  be  distinguished  from  another  and 
somewhat  similar  affection  from  which  children  not  unfrequentlv  suffer 
during  dentition,  known  as  “cliild-crowing,”  or  scientifically  as  Laryn¬ 
gismus  stridulus.  This  child-crowing  usually  takes  the  form  of  a  sud¬ 
den  convulsive  attack,  appearing  during  apparent  health,  and  arresting 
completely  for  a  few  moments  the  power  of  breathing.  As  the  spasm 
passes  off  the  breath  is  drawn  in  with  a  crowing  or  hissing  sound, 
somewhat  similar  to  what  occurs  in  spasmodic  croup.  When  a  child  is 
attacked  with  this  form  of  spasm,  it  becomes  suddenly  stiff,  throws  its 
head  backward,  and  becomes  first  pale  and  then  livid  in  the  face,  with 
staring  eyes  and  very  alarmed  expression.  Occasionally  there  is  at  the 
same  time  some  slight  convulsive  movements  of  the  hands  or  feet. 
Sometimes  for  some  days  or  even  weeks  before  such  an  attack  prelimi¬ 
nary  symptoms  are  noticed  in  the  form  of  occasional  crowing  or  croaking 
in  the  breathing,  the  presence  of  which  should  always  suggest  recourse 
to  medical  advice.  But  such  warnings  are  not  by  any  means  always 
present,  and  the  attack  may.  and  frequently  does,  come  on  without  any 
preliminary  indication  of  disease.  Its  distinction  from  spasmodic 
croup  is  easily  made  by  the  suddenness  of  the  onset,  the  complete 
arrest  of  breathing,  the  tendency  to  convulsive  movements,  and  the 
absence  of  cough.  Attacks  of  child-crowing,  if  at  all  severe,  are 
attended  with  considerable  danger  of  sudden  death  ;  and  although  one 
or  two  attacks  may  have  only  been  slight,  it  can  never  be  assumed  that 
further  ones  will  not  be  of  a  more  dangerous  type.  Children  showing 
any  tendency  to  them  should  always  be  placed  immediately  under 
medical  care,  as  much  can  be  done  to  prevent  their  recurrence. 

Treatment  of  Child=Crowing. — For  the  immediate  treatment  of 
an  attack  when  it  occurs,  the  most  convenient  remedy  is  the  applica¬ 
tion  of  a  sponge  wrung  out  of  hot  water  to  the  throat,  immediately 
under  the  chin.  The  inhalation  of  the  vapor  of  ammonia  is  also 
useful  in  relaxing  the  spasm,  and  it  is  a  good  rule  for  mothers  or  nurses 
of  children  showing  a  tendency  to  child-crowing  to  always  carry  a 
bottle  of  ammonia  salts  in  their  pockets.  If  these  remedies  are  not 
immediately  effectual,  the  child  should  be  placed  as  quickly  as  possible 
in  a  bath  of  about  98°  F. 


2i8  disorders  with  process  of  dentition. 

These  attacks  are  of  a  purely  convulsive  character,  the  spasm 
affecting  certain  muscles  connected  with  respiration,  and  temporarily 
arresting  their  movement.  Children  during  teething  are  subject  also 
to  convulsive  attacks  of  a  more  general  character,  which  are  known 
usually  as  “fits,”  or  general  convulsions. 

General  Convulsions,  like  the  attacks  above  described,  usually 
come  on  very  suddenly,  without  any  warning.  The  child  is  observed 
to  become  suddenly  stiff,  with  eyes  staring,  neck  thrown  back,  arms 
and  legs  stretched  out  and  immovable,  hands  clenched,  and  breathing 
temporarily  arrested.  The  eyes  are  often  turned  upward,  so  that 
very  little  but  the  whites  are  visible  ;  sometimes  they  are  turned  to  one 
or  the  other  side,  so  as  to  appear  to  squint.  After  a  few  seconds  con¬ 
vulsive  movements  of  the  face,  arms,  and  legs  commence.  The  face, 
which  usually  becomes  somewhat  livid,  is  twitched  in  different  direc¬ 
tions.  The  mouth  is  moved  irregularly,  and  if  the  child  has  teeth  the 
tongue  may  be  bitten,  and  froth  mixed  with  blood  appear  on  the  lips. 
The  eyes  usually  roll  from  side  to  side,  the  eyelids  being  widely  opened. 
The  arms  and  legs  twitch  usually  in  a  marked  manner,  the  twitching 
sometimes  affecting  even  the  fingers  and  toes  as  well  as  the  rest  of  the 
limbs.  From  the  commencement  of  the  attack  the  child  is  perfectly 
unconscious,  and  remains  so  during  the  whole  course,  and  even  fre¬ 
quently  for  some  little  time  after  it  has  ceased.  When  the  spasmodic 
action  ceases,  the  muscles  relax,  the  child  becomes  pale,  and  may  draw' 
a  long  sigh,  and  gradually  recovers  consciousness.  The  duration  of 
such  a  convulsive  attack  varies  very  much.  A  slight  attack  may  not  last 
more  than  one  or  two  minutes,  while  a  very  severe  attack  may  last  as 
many  hours.  Generally  speaking,  when  the  attack  is  due  to  the  irrita¬ 
tion  of  dentition,  it  will  not  be  of  long  duration. 

Although  the  general  convulsions  just  described  seem  in  some 
respects  much  more  severe  than  the  limited  attacks  known  as  cliild- 
crowing,  they  are  not  so  dangerous,  or  so  often  fatal  in  their  results. 
General  convulsions  indeed,  alarming  as  they  appear,  are  very  seldom 
fatal  to  life,  unless  their  duration  is  of  exceptional  length. 

Treatment  of  General  Convulsions.— The  best  immediate  treat¬ 
ment  is  to  place  the  child  at  once  in  a  warm  bath  of  about  98°  F.,  keep¬ 
ing  it  in  the  bath  for  five  or  ten  minutes  if  necessary.  When  taken  out  it 
should  be  rolled  in  a  w^arm  blanket  without  being  dried,  and,  if  the 
convulsions  are  not  entirely  arrested,  a  large  enema  of  warm  water 
should  be  administered  with  a  family  syringe.  Convulsions  are  very 
often  associated  with  some  disturbance  of  digestion,  as  well  as  with 
irritation  from  teething,  and  the  evacuation  of  the  bowel  resulting  from 
the  enema  is  often  followed  by  complete  cessation  of  the  convulsions. 

If  the  child  has  taken  a  meal  shortly  before  the  convulsive  attack, 
an  emetic  of  ipecacuanha  should  be  given  as  soon  as  it  is  able  to 


ABSCESS  OF  THE  EAR. 


2l9 


swallow,  and,  if  this  does  not  act  quickly,  vomiting  should  be  excited 
by  tickling  the  throat  with  the  finger.  In  doing  this,  care  must  be 
taken  that  the  finger  is  not  bitten  by  the  child. 

General  convulsions  due  to  teething  or  other  local  irritation  have 
no  special  tendency  to  recurrence  after  complete  recovery,  and  unless 
when  of  exceptional  duration  do  not  in  any  way  permanently  injure  the 
child.  Frequent  recurrence  would  indicate  the  probability  of  some 
other  and  more  serious  cause  for  the  attacks. 

Abscess  of  Ear. — One  occasional  cause  of  general  convulsions 
which  is  sometimes  overlooked,  but  which  is  not  uncommon  during 
the  period  of  teething,  is  the  presence  of  acute  inflammation  and  abscess 
of  the  ear.  This  affection  is  often  exceedingly  painful,  and  gives  rise 
to  very  persistent  screaming  in  young  children.  The  disease  is  not 
usually  difficult  of  recognition  in  children  old  enough  to  describe  their 
sensations  ;  but  in  children  under  two  years  of  age  it  is  often  rather 
difficult  of  detection,  until  the  nature  of  the  case  is  made  clear  by  the 
discharge  of  matter  from  the  ear.  The  most  characteristic  signs  of  its 
presence  are  persistent  loud  crying,  tossing  of  the  head  from  one  side 
to  the  other,  and  a  tendency  to  raise  the  hand  to  the  side  of  the  head, 
an  action  not  common  under  other  circumstances.  The  painful  stage 
of  the  disease  usually  does  not  last  more  than  a  day,  the  pain  disappear¬ 
ing  when  the  matter  is  liberated  from  the  ear.  It  is  during  the  early 
part  of  the  painful  stage  that  convulsions  are  most  likely  to  appear ; 
but  their  occurrence  is  not  frequent  in  connection  with  this  disease. 

Treatment  of  Abscess  of  Ear. — The  pain  of  inflammation  of  the 
ear  is  best  relieved  by  plugging  the  ear  with  a  little  cotton-wool 
steeped  in  laudanum,  and  applying  warm  fomentations  over  the  out¬ 
side.  The  cotton-wool  should  be  rolled  into  a  thin  cylinder,  small 
enough  to  go  into  the  opening  of  the  ear,  into  which  when  dipped  in 
laudanum  it  should  be  pushed  gently  as  far  as  possible.  Flannel 
wrung  out  of  hot  water  should  then  be  placed  over  the  ear  and  covered 
with  oiled  silk  or  gutta-percha  tissue.  If  convulsions  occur,  they  must 
be  treated  as  directed  above. 

Night  Terrors. — In  children  during  the  second  dentition  a  pecul¬ 
iar  kind  -of  mental  disturbance  occasionally  occurs,  which  is  known 
under  the  name  of  night  terrors.  The  child  wakens  up  at  night,  suffer¬ 
ing  apparently  from  some  dreadful  delusion,  starts  up  in  its  bed,  and 
screams  violently.  Occasionally  it  may  even  rise  and  rush  out  of  the 
room.  If  observed  immediately  on  waking  it  will  be  found  not  prop¬ 
erly  conscious,  remaining  often  for  some  little  time  in  a  self-absorbed 
and  “dazed”  condition  of  mind,  evidently  suffering  from  much  alarm. 
The  attacks  are  somewhat  similar  to  those  of  nightmare,  but  differ 
from  them  in  persisting  for  some  time  after  awaking.  Very  exception¬ 
ally  they  occur  during  the  day,  when  the  child  is  awake  and  apparently 


220 


DISORDERS  WITH  PROCESS  OF  DENTITION. 


well,  some  sudden  illusion  of  sight  alarming  it,  and  throwing  it  tem¬ 
porarily  into  the  same  absorbed  and  trance-like  frame  of  mind.  These 
night  terrors  and  analogous  day  disturbances  are  generally  found  asso¬ 
ciated  with  some  disorder  of  digestion,  and  will  usually  disappear 
entirely  if  one  or  two  doses  of  some  mild  purgative  medicine  are  given, 
and  due  care  is  taken  to  prohibit  indigestible  articles  of  food. 

Mental  Peculiarities  during  Second  Dentition. — The  mental 
health  of  children  during  second  dentition  is  very  unstable  ;  and  it  is 
not  improbable  that  many  acts  of  purposeless  mischief,  of  motiveless 
naughtiness,  of  inexplicable  deceit,  in  children  of  habitual  good  conduct 
and  gentle  disposition,  committed  at  this  period  of  life,  are  as  truly 
involuntary  reflex  mental  acts,  as  the  muscular  convulsions  already 
described  are  involuntary  physical  acts,  for  neither  of  which  can  the 
child  be  properly  considered  responsible. 


Arthur  Burrington% 


CHAPTER  XIX 


Common  Maladies  op  Children. 

1.  Earache  and  Discharge  from  Ear.  2.  Affections  of  Throat;  Catarrhal  In¬ 
flammation  of  Throat;  Subacute  Tonsillitis;  Diphtheritic  Inflammation; 
Distinction  between  them;-  Treatment  of  Catarrhal  Inflammation,  of  Sub¬ 
acute  Tonsillitis;  Precautions  Relating  to  Diphtheria;  Chronic  Enlargement 
of  Tonsils;  Their  Effects  on  Respiration;  Snoring.  3.  Disorders  due  to 
Cold  or  Chill;  Cold  in  the  Head,  in  Throat  and  Larynx;  Bronchitis;  Cold 
affecting  the  Stomach  and  the  Bowels.  4.  Disorders  of  the  Digestive  Or¬ 
gans;  Indigestion,  Acute  and  Chronic;  Diarrhoea;  Prolapse  of  Bowel; 
Constipation;  Treatmeat  by  Diet,  by  Injections,  by  Medicines.  5.  Erup¬ 
tions  on  the  Skin :  Heat-spots;  Roseola;  Nettle-Rash;  Eczema.  6.  Infec¬ 
tious  Eruptive  Fevers:  Chicken-pox;  Small-pox;  Scarlet  Fever;  Measles; 
Rotheln;  Mumps;  Whooping-Cough;  Responsibility  of  Parents  in  Relation 
to  Infectious  Diseases.  7.  Parasitic  Diseases:  Ringworm;  Itch;  Thread¬ 
worms.  8.  Diathetic  Diseases;  Rheumatism;  Scrofula;  Rickets. 

1 .  Earache  and  Discharge  from  the  Ear. — The  occurrence  of 
pain  of  a  more  or  less  acute  character  referred  to  the  ear  is  not  un¬ 
frequent  in  children,  and  is  due  usually  to  some  inflammation  affecting 
either  the  external  passage  of  the  ear,  or  the  middle  ear,  which  is 
situated  just  -within  the  drum.  As  has  been  already  mentioned,  it  is 
sometimes  associated  with  the  period  of  dentition,  but  other  causes, 
such  as  slight  cold,  disorder  of  the  digestion,  or  inflammation  of  the 
throat,  may  also  give  rise  to  it.  When  the  inflammation  affects  the 
external  passage  of  the  ear,  its  presence  is  usually  indicated  by  some 
degree  of  swelling  and  redness,  with  tenderness  to  touch  ;  when  the 
middle  ear  is  affected,  there  are  no  external  symptoms.  The  pain  is 
often  of  a  very  severe  character,  and  may  continue  for  many  hours, 
generally"exliibiting  paroxysms  of  acute  exacerbations  alternating  with 
periods  of  partial  relief.  In  a  certain  number  of  cases,  complete  relief 
is  afforded  in  time  by  the  discharge  of  matter  which  has  formed  as  the 
result  of  the  inflammation  ;  in  others,  the  pain  subsides  gradually  with¬ 
out  the  occurrence  of  any  discharge.  As  a  rule,  it  is  not  difficult  to 
locate  the  pain  as  arising  from  the  ear,  but  sometimes  in  children  who 
have  suffered  from  toothache,  the  pain  of  inflammation  of  the  ear  may 
be  mistaken  for  that  arising  from  decayed  teeth.  The  presence  usually 
of  some  degree  of  deafness  in  the  affected  ear  will  assist  in  the  distinc- 


222 


COMMON  MALADIES  OF  CHILDREN. 


tion  ;  sometimes  the  deafness  may  be  very  marked.  Occasionally  in¬ 
flammation  occurs  in  the  ear  without  any  pain  whatever,  and  its  exist¬ 
ence  is  only  recognized  by  the  subsequent  discharge,  or  by  persistent 
deafness. 

The  treatment  of  this  affection  is  directed  first  to  the  relief  of 
pain,  and  afterward  to  the  maintenance  of  great  cleanliness  if  any 
discharge  results.  Pain  is  best  relieved  by  the  application  to  the  pas¬ 
sage  of  the  ear  of  a  little  cotton-wool  soaked  in  laudanum,  over  which 
may  be  placed,  if  necessary,  some  flannel  wrung  out  of  hot  water  and 
covered  with  oiled  silk.  The  cotton-wool  should  be  rolled  into  a  little 
pledget,  small  enough  to  enter  the  passage  of  the  ear,  and  long  enough 
to  project  about  a  quarter  or  half  an  inch  on  the  outside,  so  that  it  may 
be  easily  withdrawn  ;  the  flannel  should  be  large  enough  to  cover  the 
whole  of  the  external  ear.  When  the  pain  is  very  severe,  the  cotton¬ 
wool  with  laudanum  should  be  changed  every  one  or  two  hours.  It  is 
always  desirable  at  the  same  time  to  administer  some  purgative  med¬ 
icine,  the  good  effect  of  which  in  relieving  pain  arising  from  the  ear  is 
often  marked.  Any  convenient  laxative  medicine,  such  as  sweet  essence 
of  senna  or  compound  licorice  powder,  in  suitable  doses,  may  be  em¬ 
ployed.  When  discharge  occurs,  the  ear  should  be  kept  thoroughly 
clean  by  frequent  syringing  with  warm  water,  to  which  it  is  generally 
desirable  to  add  a  little  antiseptic  fluid  such  as  carbolic  acid,  of  which  a 
proportion  of  one  teaspoonful  to  a  glassful,  makes  a  very  eligible 
lotion  for  this  purpose.  A  small  india-rubber  ball  syringe  is  better 
than  a  glass  one,  as  it  admits  of  more  gentle  syringing  ;  and  great  care 
should  always  be  taken  that  the  syringing  is  performed  as  gently  as 
possible,  so  as  to  avoid  any  risk  of  injuring  the  already  inflamed  and 
tender  tissues.  If  the  discharge  continues  for  more  than  two  or  three 
days,  it  is  well  to  have  resort  to  skilled  medical  advice.  The  existence 
of  discharge  from  the  ear  is  always  an  indication  of  possible  danger, 
not  only  to  the  hearing  power  of  the  ear,  but  also  to  the  life  of  the 
child.  The  ear  is  in  such  close  proximity  to  the  brain  that  inflamma¬ 
tion  of  the  one  is  somewhat  apt  to  extend  to  the  other  ;  and  inflamma¬ 
tion  of  the  brain  is  always  a  serious  and  often  a  fatal  disease.  It  is  there¬ 
fore  most  important  never  to  neglect  the  existence  of  any  discharge 
from  the  ear.  An  idea  used  to  be  prevalent  that  the  arrest  of  discharge 
from  the  ear  was  attended  with  risk.  The  only  foundation  for  such  a 
belief  is  that  it  is  undoubtedly  dangerous  to  shut  up  the  discharge  in 
the  ear  by  preventing  it  getting  out  ;  but  it  is  not  in  any  way  dangerous 
to  prevent  its  formation  by  curing  the  disease  from  which  it  arises. 
The  mischief  which  may  arise  from  shutting  in  the  discharge  is  sufficient 
reason  for  condemning  strongly  the  common  practice  of  keeping  a  plug 
of  cotton-wool  in  ears  affected  with  discharge.  Such  a  plug  is  not  only 
absolutely  valueless,  but  may  be  a  source  of  some  danger. 


AFFECTIONS  OF  THE  THROAT. 


223 


Short  reference  has  been  made  to  a  form  of  inflammation  showing 
itself  only  by  the  presence  of  deafness.  Deafness  resulting  from  this 
is  apt  to  be  progressive  in  character,  and  is  difficult  to  cure  in  propor¬ 
tion  to  the  duration  of  its  existence  ;  those  responsible  for  the  health 
of  children  ought  therefore  to  take  the  earliest  opportunity  of  obtaining 
medical  advice  when  its  existence  in  any  degree  becomes  apparent. 

2.  Affections  of  the  Throat.  Description  and  Method  of 
Examination. — If  a  child  opens  its  mouth  widely,  and  the  view  within 
is  not  obstructed  by  the  tongue,  the  roof  of  the  mouth  will  be  seen  to 
terminate  behind  in  an  arch,  from  the  middle  of  which  a  pendulous 
piece  of  tissue  is  suspended, 
which  is  known  as  the  uvula . 

At  each  extremity  of  the  arch 
a  projecting  oval-sliaped 
body  will  be  observed,  which 
forms  part  of  the  side  of  the 
mouth  behind  the  teeth,  and 
extends  back  toward  the 
throat ;  these  are  called  the 
tonsils.  The  cavity  seen  be¬ 
hind  these  tonsils  is  known 
as  the  pharynx,  which  is  con¬ 
tinuous  below  with  the  gullet. 

The  windpipe  opens  out  of 
the  pharynx  near  its  lower 
end  in  front  Not  unfre- 
quently  a  clear  view  of  the 
pharynx  is  impeded  by  the 
position  of  the  tongue,  which 
some  children  are  unable  to 
place  voluntarily  in  such  a  position  as  to  admit  of  the  throat  being  well 
seen.  The  difficulty  can  usually  be  surmounted  by  causing  the  child 
to  take  a  deep  inspiration,  while  it  pronounces  at  the  same  time  the 
syllable  “Ah,”  an  action  which  depresses  the  tongue  and  dilates 
the  throat,  so  that  its  condition  can  be  thoroughly  examined.  When 
the  child  cannot'or  will  not  do  this,  some  flat  instrument,  such  as  the 
handle  of  a  spoon,  should  be  laid  on  the  tongue  to  maintain  it  in  proper 
position.  Sometimes  the  view  of  the  pharynx  is  obstructed  by  en¬ 
largement  of  the  tonsils,  which  may  be  of  such  a  size  as  to  meet  in  the 
middle  line  ;  in  such  a  case,  when  it  is  desired  to  examine  the  condition 
of  the  throat  behind  them,  they  must  be  separated  by  the  flat  handle 
of  a  spoon  being  pressed  against  the  inner  surface  of  each  tonsil. 
Throats  should  always  be  examined  in  the  best  attainable  light ;  when 
daylight  is  available,  the  examiner  should  sit  with  his  back  to  the 


Fig.  128. 


THE  NOSTRILS  AS  SEEN  FROM  BEHIND — BY  A 
MIRROR  IN  THE  THROAT — WHEN  THE  MEM¬ 
BRANES  ARE  PUFFED  UP  WITH  CATARRHAL 
INFLAMMATION  AND  BREATHING  IS  IMPEDED. 
THE  UVULA  PROJECTS  BELOW  IN  THROAT- 
ARCH. 


224 


COMMON  MALADIES  OF  CHILDREN. 


light,  while  the  child  sits  or  stands  facing  it.  The  child’s  head  should 
he  thrown  somewhat  backward,  so  that  the  light  falls  into  the  throat 
over  the  head  of  the  person  making  the  examination. 

The  throat  in  children  is  a  particularly  vulnerable  part  of  the  body. 
It  is  therefore  well,  in  order  to  facilitate  its  examination  during  illness, 
for  mothers  and  nurses  to  accustom  children  to  open  their  mouths  fully 
and  exhibit  their  throats  occasionally  during  health.  When  children 
have  not  been  trained  to  do  this,  there  is  often  an  unpleasant  struggle 
when  inspection  of  the  throat  is  necessitated  by  illness  ;  while,  when 
habituated  to  show  their  throats  properly,  not  only  inspection  but  any 
local  treatment  necessary  can  be  effected  with  ease,  and  without  dis¬ 
comfort  to  them. 

The  throat  is  apt  to  become  inflamed  from  simple  cold,  from  dis¬ 
turbance  of  the  stomach,  from  inhaling  impure  air,  and  from  drinking 
impure  water,  as  well  as  from  various  other  causes  affecting  the 
general  health  ;  and  the  character  and  seat  of  the  inflammation  not 
unfrequently  give  some  clue  to  the  special  cause  from  which  it  takes 
its  origin.  It  is  proposed  to  describe  here  only  three  forms,  which  are 
sufficiently  distinct  usually  to  be  easily  recognized,  while  all  are  of 
moderately  frequent  occurrence. 

(a)  Catarrhal  Inflammation  of  Throat. — The  first  and  most 
common  form  is  known  as  simple  catarrhal  inflammation  of  the  throat, 
and  is  generally  due  to  exposure  to  cold.  If  suffering  from  this,  a 
child  who  is  able  to  talk  will  complain  of  a  sense  of  dryness  in  the 
throat,  with  discomfort  in  swallowing,  sometimes  amounting  to  pain, 
and  occasionally  of  pain  shooting  up  into  the  ears.  A  younger  child 
will  show  a  disinclination  to  swallow,  at  the  same  time  that  it  may 
exhibit  a  strong  wish  for  food.  It  will  commence  sucking  its  bottle 
with  avidity,  but  leave  off  almost  immediately,  often  with  a  fit  of  cry¬ 
ing  in  which  a  little  hoarseness  may  sometimes  be  noticed,  although 
hoarseness  is  not  a  frequent  characteristic  of  this  affection  of  the  throat. 
If  the  throat  be  examined  in  a  good  light,  it  will  be  noticed  that  the 
tonsils  and  the  back  of  the  pharynx  are  of  a  much  darker  red  than  usual, 
exhibiting  a  dusky  hue,  and  being  occasionally  covered  with  rather 
adhesive  mucus.  The  uvula  also  will  sometimes  be  deepened  in  color, 
and  occasionally  somewhat  swollen.  As  a  rule,  there  is  no  external 
tenderness  or  swelling,  but  sometimes  a  little  complaint  may  be  made 
if  the  outside  of  the  throat  is  pressed  upon. 

(b)  Subacute  Tonsillitis. — The  second  form  of  inflammation  of 
the  throat  affects  mainly  the  tonsils,  being  known  as  subacute  tonsil¬ 
litis  ;  this  form  is  more  frequently  the  result  of  irritation  of  the  diges¬ 
tion,  or  of  the  inhalation  of  impure  air,  or  the  drinking  of  contamina¬ 
ted  water.  The  amount  of  pain  experienced  in  swallowing  is  not  so 
great  as  in  the  catarrhal  form,  but  there  is  a  constant  sense  of  dis- 


TONSILLITIS  AND  DIPHTHERIA. 


225 


comfort  in  the  throat,  and  sometimes  a  desire  to  clear  it  by  coughing. 
Generally  some  swelling  can  be  perceived  externally,  just  under  the 
angle  of  the  jaw  on  each  side  ;  if  it  cannot  be  appreciated  by  the  sense 
of  sight,  its  presence  is  often  demonstrated  by  that  of  touch,  a  small 
area  of  increased  hardness  being  felt  to  project  beneath  the  skin  in  the 
position  mentioned. 

On  inspection  of  the  interior  of  the  throat,  both  tonsils  usually, 
sometimes  only  one,  are  seen  to  be  enlarged,  swollen,  and  reddened, 
and  to  project  inw^ard  toward  the  uvula.  Very  commonly  their  inner 
surfaces  will  be  seen  to  be  dotted  here  and  there  with  white  points, 
varying  in  size  from  a  pin’s  head  to  a  split  pea  ;  occasionally  these 
surfaces  will  be  entirely  covered  with  a  whitish-yellow  deposit  of  a 
soft-looking  and  somewhat  putty-like  appearance.  This  deposit,  which 
is  strictly  limited  in  area  to  the  surface  of  the  tonsils,  not  extending 
backward  into  the  pharynx,  or  upward  on  the  roof  of  the  mouth  and 
uvula,  occasionally  comes  off  in  flakes,  leaving  a  healthy  red  surface 
underneath.  These  characters  serve  to  distinguish  it  from  the  deposit 
present  in  the  third  form  of  inflammation  of  the  throat,  diphtheritic 
inflammation,  or  diphtheria. 

(c)  Diphtheritic  Inflammation  of  the  throat  is  apt  to  begin  in  a 
very  insidious  manner,  often  giving  rise  at  first  to  only  a  very  little 
discomfort.  The  child  usually  seems  somewhat  ill  and  out  of  sorts,  ' 
with  the  temperature  slightly  raised,  for  a  day  or  two  before  any  com¬ 
plaint  is  made  of  local  discomfort  in  the  throat.  When  attention  is 
called ‘to  the  throat  early  in  the  disease,  all  that  may  be  noticeable  may 
be  some  very  dusky  red  patches  of  inflammation  scattered  here  and 
there  on  the  tonsils,  uvula,  the  roof  of  the  mouth,  or  the  back  of  the 
pharynx  ;  or,  if  the  case  is  to  be  a  severe  one,  the  whole  of  the  throat 
may  appear  of  deeply  red  and  angry-looking  character.  When  seen  a 
day  or  so  later  the  red  patches,  or  the  throat  generally,  will  be  observed 
to  be  covered  with  a  thin  whitish  membrane,  smooth  on  the  surface 
and  sometimes  almost  glistening,  which  is  surrounded  with  a  deepened 
red  border  separating  it  from  the  healthy  lining  of  the  throat.  As  the 
disease  progresses,  the  membrane  becomes  changed  in  color,  altering 
from  white  into  whitish  yellow,  then  into  deep  yellow,  and  sometimes 
becoming  gray,  or  even  black.  At  the  same  time  its  surface  loses  its 
smooth  and  glistening  appearance,  and  becomes  somewhat  roughened, 
opaque,  and  leathery. 

Distinction  between  Tonsillitis  and  Diphtheria. — Diphtheria 
is  always  a  disease  of  serious  import,  requiring  immediate  skilled  med¬ 
ical  treatment,  and  it  is  accordingly  very  important  to  distinguish  it 
from  the  comparatively  benign  affection  of  the  throat  already  described 
as  Subacute  Tonsillitis,  for  v^liich  under  some  conditions  it  is  apt  to  be 

mistaken.  The  distinction  rests  mainly  on  the  character  and  nppt-ia*- 

8 


COMMON  MALADIES  OF  CHILDREN. 


2  26 

ance  of  the  exudation  in  tonsillitis,  and  on  its  strict  limitation  to  the 
surface  of  the  tonsils.  In  diphtheria  the  exudation  never  occurs  in  the 
form  of  small  disseminated  points  over  the  surface  of  the  tonsils. 
When  it  appears  on  the  tonsils  at  all,  it  takes  the  form  of  one  or  more 
patches  of  varied  size.  The  color  of  the  patches  of  diphtheria  on  the 
tonsils  is  alscf  different  at  first  from  the  points  of  tonsillar  exudation 
present  in  tonsillitis.  Diphtheritic  patches  are  at  first  white  and  glisten¬ 
ing,  while  patches  of  tonsillar  exudation  are  from  the  first  of  a  dirty- 
yellowish  color.  The  real  difficulty  in  distinguishing  the  two  is  en¬ 
countered  when  the  tonsillar  exudation  in  subacute  tonsillitis  covers  the 
whole  surface  of  the  tonsils.  In  such  a  case  the  throat  presents  a  con¬ 
siderable  resemblance  to  a  diphtheritic  throat,  but  the  soft-looking, 
putty-like  character  of  the  exudation,  its  strict  limitation  to  the  surface 
of  the  tonsils,  and  the  healthy  appearance  of  the  whole  of  the  rest  of 
the  throat  are  generally  sufficient  to  indicate  the  milder  disease.  A 
point  of  distinction  occasionally  available  is  the  facility  with  which 
part  of  the  tonsillar  exudation  can  be  sometimes  scraped  off  with  the 
handle  of  a  spoon.  Diphtheritic  membrane  can  never  be  separated  in 
this  way,  as  it  actually  grows  into  the  substance  of  the  tissue  on  the 
surface  of  which  it  appears.  The  appearance  of  any  patch  of  mem¬ 
brane  on  the  roof  of  the  mouth  or  on  the  back  of  the  pharynx  is  con¬ 
clusive  evidence  of  Diphtheria. 

[Colored  illustrations  of  eight  common  throat  diseases  are  to  be 
found  in  Dr.  Foote’s  New  Book  on  Health  and  Disease,  with  Recipes. 
See  advertising  pages.] 

The  Treatment  of  ordinary  Catarrhal  Inflammation  of  the 
Throat  consists  mainly  in  the  maintenance  of  wTarmth,  confinement 
to  bed  when  any  feverishness  is  present,  and  the  application  of  sooth¬ 
ing  remedies  to  the  throat.  Externally,  water  compresses  usually  give 
the  most  relief,  applied  from  ear  to  ear,  and  renewed  once  or  twice  daily. 
If  relief  is  not  afforded  by  compresses,  linseed  meal  poultices  should 
be  employed,  changed  as  frequently  as  may  be  necessary.  [And  these 
poultices  should  be  well  spread  or  “  buttered  ”  with  the  Magnetic 
Ointment.]  Internally,  the  sucking  of  small  pieces  of  ice  occasionally, 
or  the  sipping  of  small  quantities  of  iced  water,  is  most  grateful.  It  is 
usually  well  to  give  a  mild  dose  of  laxative  medicine,  and  the  food 
administered  should  be  such  as  can  be  swallowed  with  little  pain,  and 
is  capable  of  easy  digestion.  Milk,  farinaceous  foods,  lightly  boiled 
eggs,  and  thickened  soups  or  beef  jellies  fulfil  well  these  conditions. 

Treatment  of  Subacute  Tonsillitis. — In  subacute  tonsillitis  the 
external  application  of  water  compresses  or  poultices  is  equally  effective. 
Internally,  the  application  of  some  astringent  remedy  with  a  camel’s- 
hair  brush  two  or  three  times  daily  is  advisable  ;  glycerine  of  borax 
or  glycerine  of  alum  may  be  selected  for  this  purpose,  •  It  is  always 


PRECAUTIONS  ABOUT  DIPHTHERIA. 


227 


desirable  to  act  well  on  the  bowels  of  the  patient  with  some  suitable 
purgative,  such  as  compound  licorice  powder  or  “black  draught” 
(mistura  sennse  co.),  in  doses  proportionate  to  the  age  of  the  child  ;  and 
care  should  be  exercised  in  the  choice  of  easily  digested  food.  When 
feverish  symptoms  exist,  the  child  should  be  kept  in  bed. 

It  is  out  of  place  to  say  anything  about  the  treatment  of  diphtheria  ; 
it  is  a  malady  of  so  serious  a  character  that  any  sufferer  from  it  should 
always  be  placed  as  quickly  as  possible  under  the  care  of  a  medical 
practitioner. 

Precautions  Relating  to  Diphtheria. — Diphtheria  is  a  disease  of 
exceedingly  infectious  character,  and  on  the  first  suspicion  of  its  pres¬ 
ence  the  patient  should  be  most  carefully  isolated  from  the  rest  of  the 
household.  Its  occurrence  in  any  house  ought  always  to  excite  suspi¬ 
cion  of  the  probability  of  some  defect  in  the  drainage  or  the  water- 
supply,  as  it  is  especially  prone  to  appear  under  such  conditions  ;  and 
even  if  not  due  to  either  of  these  causes,  the  course  of  the  disease  is 
usually  determined  to  a  considerable  degree  by  the  sanitary  conditions 
under  which  the  treatment  is  carried  out. 

There  is  some  ground  for  believing  that  even  ordinary  catarrhal 
inflammation  of  the  throat,  and  also  subacute  tonsillitis,  are  occasionally 
caught  by  infection,  although  generally  due  to  other  causes  ;  and 
although  it  is  not  usually  thought  necessary  to  isolate  children  suffer¬ 
ing  from  those  affections,  it  is  well  to  prevent  such  close  contact  as  is 
involved  in  sleeping  in  the  same  bed  with  or  in  kissing  other  children. 

(d)  Chronic  Enlargement  of  Tonsils. — This  affection  of  the  ton¬ 
sils,  which  is  sometimes  known  under  the  name  of  “  hypertrophy  of 
the  tonsils,”  is  not  usually  the  result  of  inflammation,  although  tonsils 
permanently  increased  in  size  are  perhaps  more  likely  to  become  in¬ 
flamed  than  normal  ones.  The  tendency  to  enlarged  tonsils  is  often 
congenital,  and  not  unfrequently  affects  the  whole  of  the  members  of 
a  family.  When  the  congenital  tendency  is  present,  the  increase  in 
size  may  appear  at  any  age  from  one  year  up  to  thirteen  or  fourteen. 
Often  the  increase  occurs  by  successive  stages,  the  tonsils  remaining 
for  some  time  stationary  in  size,  and  as  the  result  of  some  cold  or  other 
disturbance  increasing  rather  rapidly,  retaining  their  new  and  increased 
size  for  some  time,  and  then  again  making  another  advance.  The  rec¬ 
ognition  of  enlarged  tonsils,  on  inspection  of  the  throat,  is  very  easy. 
Tonsils  normally  project  scarcely  at  all  beyond  the  line  of  the  mouth 
and  throat,  being  seen  simply  as  very  slight  protuberances,  more 
noticeable  on  account  of  their  difference  of  appearance  from  the  rest  of 
the  throat  than  from  their  prominence.  When  they  are  enlarged  to 
any  extent,  they  project  well  into  the  throat,  partly  shutting  off  the 
view  of  the  pharynx  behind,  and  presenting  the  appearance  of 
little  tumors.  Sometimes  the  hypertrophy  is  to  such  an  extent  that 


228 


COMMON  MALADIES  OF  CHILDREN. 


the  tonsils  actually  touch  each  other  iu  the  centre  of  the  throat, 
apparently  blocking  the  passage  altogether,  and  pushing  the  uvula 
forward  out  of  their  way.  The  hypertrophy  sometimes  affects  only 
one  of  the  tonsils,  but  more  frequently  both  are  enlarged,  although  not 
uncommonly  to  unequal  extent.  Whatever  the  degree  of  enlargement 
may  be,  the  color  of  the  tonsils  usually  remain  the  same  as  in  health. 

Effects  of  Enlarged  Tonsils  of  Respiration. — Enlarged  tonsils 
are  important  chiefly  in  relation  to  the  extent  they  may  impede  breath¬ 
ing  through  the  nostrils.  In  themselves  they  are  not  a  source  of  injury 
to  health  or  of  danger,  as  no  amount  of  enlargement  can  ever  induce 
dangerous  symptoms  ;  but  by  impeding  the  breathing  through  the  nos¬ 
trils,  they  not  only  are  often  the  cause  of  considerable  discomfort,  es¬ 
pecially  during  the  night,  but  in  time  not  unfrequently  give  rise  to 
alterations  in  the  shape  of  the  chest,  with  resulting  impairment  of  lung 
power.  Even  when  the  impediment  to  breathing  may  be  slight,  if  it  is 
in  continuous  action  for  months  or  years,  the  chest  tends  to  give  way 
under  the  increased  wTork  it  has  to  do  to  draw  in  the  proper  amount  of 
air  ;  the  sides  of  the  ribs  become  drawn  inward,  the  breast  bone  pro¬ 
jects,  and  the  condition  results  which  when  marked  is  known  under  the 
name  of  pigeon-breast . 

When  the  tonsils  are  hypertrophied,  the  breathing  through  the 
nostrils  is  impeded  in  two  different  ways.  In  the  first  place,  the  en¬ 
larged  tonsils  often  project  backward  as  well  as  inward,  and  thus 
encroach  on  the  air-passage  between  the  nostrils  and  the  windpipe ; 
in  the  second  place,  their  enlargement  frequently  gives  rise  to  a  little 
catarrhal  inflammation  of  the  back  of  the  nose  and  throat,  accompanied 
by  slight  swelling  of  the  lining  membrane  and  increased  secretion  of 
mucus,  which  still  further  contracts  the  available  air-passage.  The 
first  symptom  which  usually  calls  attention  to  the  impediment  of 
breathing  arising  from  enlarged  tonsils  is  persistent  snoring  at  night. 
Snoring  only  occurs  when  the  mouth  is  kept  open  during  sleep  ;  and  in 
children  at  least  this  condition  is  abnormal,  and  always  indicates  the 
presence  of  some  disturbing  cause,  the  most  frequent  being  enlarge¬ 
ment  of  the  tonsils.  In  advanced  cases,  during  the  day  also  difficulty 
of  nasal  breathing  may  be  observed,  and  the  child  will  be  noticed 
to  keep  its  mouth  open,  and  sometimes  to  make  a  disagreeable  noise 
like  very  subdued  snoring. 

When  persistent  snoring  at  night  is  remarked,  it  is  always  well 
to  examine  the  condition  of  the  throat.  In  considering  the  treatment, 
the  main  question  to  be  decided  is  as  to  how  much  the  enlarged  tonsils 
themselves  are  the  cause  of  the  difficulty,  and  how  far  it  may  be 
attributed  to  the  resulting  inflammation  of  the  throat.  When  consider¬ 
able  inflammation  is  indicated  behind  the  tonsils  by  deepness  of  color 
and  excess  of  mucus,  it  is  wrcll  to  try  to  improve  this  by  astringent 


SNORING;  CHILL  AND  COLDS. 


229 


applications,  such  as  glycerine  of  alum  or  of  borax,  made  twice  dail}T 
with  a  long  camel’s-hair  brush,  and  to  see  if  the  breathing  improves  as 
the  inflammation  diminishes.  When  no  improvement,  or  no  sufficient 
improvement,  results  in  two  or  three  weeks,  it  is  well  to  have  the 
tonsils  excised.  This  is  a  comparatively  slight  and  painless  operation, 
and  its  results  are  almost  invariably  thoroughly  satisfactory.  A  con¬ 
dition  which  imperatively  calls  for  this  operation  is  the  occurrence  of 
deafnes^  in  either  of  the  ears  as  a  result  of  the  secondary  catarrhal  in¬ 
flammation  in  the  throat,  unless  the  deafness  disappears  entirely  by 
treating  the  catarrh  with  astringent  applications.  This  form  of  deaf¬ 
ness  is  very  insidious,  generally  being  attended  with  no  pain  or  dis¬ 
comfort  whatever,  and  unless  discovered  early  and  treated  properly, 
irreparable  harm  to  the  ear  may  result.  When  the  existence  of  enlarged 
tonsils  is  known,  parents  and  nurses  should  always  be  watchful  for 
any  s}rmptoms  of  deafness. 

The  treatment  of  enlarged  tonsils,  which  are  not  of  size  sufficient 
to  cause  any  difficulty  in  nasal  breathing,  is  mainly  directed  to  the  pre¬ 
vention  of  further  enlargement,  and  depending  as  it  does  on  various 
constitutional  considerations,  as  wTell  as  local  conditions,  does  not  fall 
within  the  scope  of  this  work.  Judicious  medical  advice  is  always 
required  in  those  cases.  [See  pages  1224-26.] 

Snoring  may  result  from  other  causes  impeding  breathing  through 
the  nostrils,  as  well  as  from  enlarged  tonsils.  Catarrh  of  the  throat, 
similar  to  that  induced  by  enlarged  tonsils,  may  arise  in  other  ways,  and 
be  present  to  such  an  extent  as  of  itself  to  encroach  to  an  injurious 
extent  on  the  air-channel.  Various  diseases  affecting  the  nostrils  also 
give  rise  to  it.  The  important  point  to  be  kept  in  view  is  that  per¬ 
sistent  snoring  in  children  from  any  cause  whatever  indicates  the 
presence  of  some  impediment  to  breathing,  and  that  the  continuous 
presence  of  that  impediment  is  certain  sooner  or  later  to  do  injury  to 
the  chest,- and  therefore  to  the  lung-power  of  the  child.  Such  injury 
is  exceedingly  difficult  to  rectify  in  later  years;  it  is  therefore  most 
desirable  that  the  impediment  should  be  medically  treated,  and  if 
possible  removed,  at  the  earliest  possible  date  after  its  recognition. 

3.  Disorders  Due  to  Cold  or  Chill. — In  any  climate  where  sudden 
changes  of  temperature  are  very  common,  various  affections  resulting 
from  chill  or  from  “taking  cold”  are  naturally  frequent.  Different 
children  manifest  the  results  of  a  chill  in  different  ways,  and  it  will  not 
unfrequently  be  observed  that  children  belonging  to  one  family  show 
a  family  resemblance  in  their  manner  of  exhibiting  the  effects  of 
“  taking  cold.”  Some  children,  when  chilled,  invariably  suffer  from 
nasal  catarrh,  or  cold  in  the  head ;  others  as  invariably  are  attacked 
with  catarrh  of  the  throat  or  windpipe,  while  others  again  manifest 
symptoms  of  bronchitis,  or  of  irritation  of  the  stomach  or  bowels. 


230 


COMMON  MALADIES  OF  CHILDREN. 


Symptoms  of  Chill. — Whatever  form  the  cold  is  about  to  assume, 
it  usually  commences  with  a  feeling  of  chilliness,  some  languor  and 
disinclination  for  play,  often  some  want  of  appetite,  and  frequently  a 
desire  for  sleep.  These  symptoms  are  usually  accompanied  or  im¬ 
mediately  followed  by  some  slight  rise  of  temperature.  In  this 
respect  children  vary  very  much.  Some,  with  apparently  very  slight 
cause,  will  show  a  rise  of  temperature  of  four  or  five  degrees,  their 
temperature  rising  to  102°  F.  or  103°  F.,  while  others  seemingly  much 
more  ill  will  exhibit  a  rise  of  only  one  or  two  degrees,  or  even  may 
have  a  temperature  absolutely  normal.  The  height  of  the  temperature 
of  a  child  is  thus  a  very  unreliable  guide  as  affording  a  measure  of  the 
severity  of  an  illness,  unless  the  special  temperament  of  the  child  is 
known  beforehand.  A  much  more  important  fact  in  children  is  the 
duration  of  an  increased  temperature.  Even  in  slight  illness  a  high 
temperature  may  be  observed  temporarily,  but  a  high  temperature 
continuing  for  more  than  twenty-four  hours  ought  always  to  excite 
strong  suspicion  that  something  more  than  a  cold  exists. 

(a)  Cold  in  the  Head. — When  the  cold  affects  the  head  only,  a 
feeling  of  fulness  and  stuffiness  in  the  nose  is  experienced,  with  perhaps 
slight  frontal  headache  in  older  children  ;  and  breathing  through  the 
nostrils  is  much  impeded,  if  not  rendered  quite  impossible.  This 
is  accompanied  by  a  discharge  of  watery  mucus  from  the  nostrils, 
which  is  often  of  an  irritating  character,  causing  redness  and  soreness 
of  the  upper  lip.  In  a  day  or  two  the  discharge  becomes  thicker  and 
more  yellow  in  color,  at  the  same  time  losing  its  irritating  character  ; 
the  stuffiness  and  difficulty  of  nasal  breathing  then  diminish,  and 
recovery  usually  results  in  a  few  days. 

(b)  Cold  Affecting  Throat  and  Larynx. — The  effect  of  cold  when 
it  affects  the  throat  and  causes  catarrhal  inflammation  has  already  been 
described  under  “  Affections  of  the  Throat  ”  at  the  beginning  of  this 
chapter.  When  its  effect  is  manifested  mainly  in  the  upper  part  of  the 
windpipe,  or  ‘‘larynx/’  as  it  is  termed,  the  first  symptom  is  usually  a 
slight  degree  of  hoarseness  of  the  voice,  often  accompanied  by  a  short, 
sharp  cough,  of  what  is  known  as  a  “  croupy  ”  character.  The  hoarse¬ 
ness  may  increase  to  such  an  extent  that  the  child  is  only  able  to  speak 
in  a  rough  whisper,  while  the  cough  alters  in  character,  becoming- 
hoarse,  barking,  and  occasionally  accompanied  with  some  discomfort  or 
even  pain  referred  to  the  throat.  There  is  very  seldom  any  expectora¬ 
tion  of  any  kind  in  this  form  of  cold.  Sometimes,  in  severe  cases,  there 
may  be  a  little  difficulty  of  breathing  at  night,  showing  itself  in  rather 
long-drawn  acts  of  inspiration.  There  is  never  in  this  affection  any 
difficulty  in  expiration.  It  is  when  suffering  from  this  form  of  cold 
that  children  are  sometimes  affected  by  attacks  of  spasmodic  croup,  such 
as  have  already  been  described  as  occurring  during  dentition  in  Chapter 


BRONCHITIS. 


231 

XVIII.  The  child,  having  fallen  asleep  comfortably,  is  awakened 
suddenly  with  a  sensation  of  choking,  starts  up  staring  wildly  and 
gasping  for  breath,  and  coughs  almost  continuously  for  some  little 
time,  with  a  short,  noisy,  hoarse  cough,  drawing  its  breath  with  diffi¬ 
culty  in  the  intervals  of  the  cough,  and  making  a  whistling,  stridulous 
noise  in  doing  so.  When  the  attack  is  severe,  the  child  is  usually 
much  frightened  ;  and  if  of  long  duration,  the  face  often  becomes 
swollen  and  livid.  Generally,  after  a  period  varying  from  two  or  three 
minutes  to  half  an  hour,  the  spasmodic  attack  subsides  entirely,  and 
the  child  again  falls  quietly  to  sleep.  Some  children  are  specially  prone 
again  to  such  attacks,  suffering  from  them  to  some  extent  with  every 
access  of  cold  affecting  their  larynx. 

This  form  of  cold- affecting  the  upper  part  of  the  windpipe  is  very 
apt  to  develop  into  bronchitis.  When  it  does  not  do  so,  recovery  is 
characterized  by  a  gradual  cessation  of  the  croupy  cough,  and  by  the 
restoration  of  the  healthy  tone  of  the  voice.  When  bronchitis  results, 
it  lias  the  same  character  as  when  it  occurs  as  the  first  manifestation  of 
cold,  with  the  addition  that  the  hoarseness  of  the  voice  usually  con¬ 
tinues  to  some  extent  until  recovery  from  the  bronchitis,  and  that  the 
bronchitic  cough  is  somewhat  modified  in  character  by  the  coexistence 
of  the  hoarseness. 

(c)  Bronchitis,  when  resulting  from  cold,  is  usually  indicated  first 
by  the  presence  of  cough — dry,  short,  and  resonant  in  character.  The 
cough  may  be  accompanied  by  some  slight  audible  wheezing  in  the 
chest,  which  is  best  heard  by  placing  the  ear  flatly  against  either  the 
breast  or  back  of  the  child.  Sometimes  there  is  a  little  increased  fre¬ 
quency  of  breathing,  but  not  to  a  notable  extent,  unless  the  bronchitis 
is  severe.  Occasionally,  indeed,  if  the  wheezing  is  very  marked,  the 
breathing  may  be  somewhat  slower  than  usual,  some  difficulty  being 
experienced  during  inspiration.  The  distinction  between  the  difficulty 
of  inspiration  in  bronchitis  from  that  sometimes  occurring  in  cold 
affecting  the  larynx  is  easily  made,  as  when  the  larynx  is  affected  there 
is  a  distinct  whistling,  hissing  noise  while  the  breath  is  drawn  in,  which 
does  not  occur  in  bronchitis.  If  any  noise  exists  during  inspiration  in 
bronchitis,  it  is  of  a  wheezing  character,  easily  recognized  as  coming 
from  the  chest. 

When  bronchitis  has  existed  for  one  or  two  days,  the  cough  usually 
changes  a  little  in  character,  becoming  softer  and  looser  ;  and  at  the 
same  time  the  wheezing  usually  diminishes  or  disappears,  being  suc¬ 
ceeded  by  moist  gurgling  sounds,  as  of  air  passing  through  fluid. 
When  this  stage  is  reached,  older  children  generally  begin  to  expec¬ 
torate  a  little  mucus  with  the  cough.  This  is  at  first  usually  white, 
gelatinous,  and  adhesive  in  character,  gradually  becoming  more  fluid, 
and  more  yellow  in  color,  as  recovery  progresses.  It  is  very  seldom 


232 


COMMON  MALADIES  OF  CHILDREN. 


that  children  under  five  years  of  age  can  he  taught  to  expectorate.  By 
the  cough  the  mucus  is  thrown  up  into  the  throat,  and  while  older 
children  by  voluntary  effort  bring  it  into  the  mouth  and  expectorate  it, 
younger  children  involuntarily  swallow  it,  and  as  a  result  often  suffer 
from  pain  in  the  stomach  and  disorder  of  the  bowels.  Sometimes  the 
cough  may  be  severe  enough  to  cause  some  vomiting  and  retching, 
which  brings  up  both  some  of  the  mucus  contained  in  the  bronchial 
tubes  and  any  that  has  been  swallowed,  and  has  remained  in  the 
stomach.  When  the  treatment  of  bronchitis  is  described,  it  will  be 
seen  that  this  natural  method  of  evacuating  the  mucus  is  sometimes 
imitated  by  the  administration  of  emetics.  As  recovery  progresses  the 
cough  becomes  less  frequent,  less  rattling  or  bubbling  is  heard  in  the 
chest,  and  the  expectoration,  if  any  has  been  present,  gradually 
diminishes. 

( d )  Cold  affecting  the  Stomach  usually  manifests  itself  in  pain 
of  an  aching  character  localized  in  the  pit  of  the  stomach,  with  slight 
tenderness  on  pressure,  sensations  of  sickness,  sometimes  amounting  to 
actual  vomiting,  and  distaste  for  food.  Very  seldom  is  headache  com¬ 
plained  of,  the  gastric  disturbance  due  to  cold  in  this  respect  differing 
from  that  which  is  the  result  of  the  ingestion  of  unsuitable  food,  when 
some  degree  of  headache  is  generally  present.  If  the  tongue  of  the 
child  be  examined,  it  will  usually  be  found  somewhat  furred,  or  else  a 
little  dry  and  of  a  brighter  red  color  than  usual.  The  disturbance  of 
the  stomach  due  to  cold  is  apt  to  continue  for  some  little  time,  showing 
occasional  periods  of  improvement  in  which  all  sense  of  pain  is  lost, 
and  again  becoming  more  severe  with  a  return  of  the  pain.  Its  dura¬ 
tion  is  often  materially  increased  by  the  administration  of  indigestible 
and  improper  food. 

(e)  When  the  Bowels  are  affected  by  Cold  the  most  frequent 
symptom  is  diarrhoea,  with  loose  and  watery  motions.  There  may  be  a 
little  pain  and  tenderness  over  the  lower  part  of  the  abdomen,  but  this 
is  often  entirely  absent  ;  when  present  it  is  not  usually  at  all  severe, 
and  of  only  temporary  duration.  Not  unfrequently  the  affection  of 
the  stomach  and  that  of  the  bowels  occur  simultaneously. 

Of  the  affections  here  described  as  commonly  resulting  from  cold, 
only  one — bronchitis — is  at  all  likely  to  assume  a  serious  or  dangerous 
character.  Undoubtedly  the  paroxysmal  attacks  occasionally  associated 
with  inflammation  of  the  upper  part  of  the  windpipe,  the  larynx,  present 
often  an  alarming  aspect,  but  they  very  seldom  indeed  are  of  such 
severity  or  duration  as  seriously  to  threaten  the  life  of  the  child,  and 
as  a  rule  they  are  very  amenable  to  suitable  treatment.  Bronchitis,  on 
the  other  hand,  especially  in  young  children,  and  those  of  not  very 
robust  constitution,  is  very  apt  to  assume  a  severe;  character,  which 
often  gives  rise  to  much  anxiety,  and  not  unfrequently  endangers  life. 


THE  TREATMENT  OF  COLD. 


233 


The  symptom  which  most  readily  indicates  seriousness  and  approaching 
danger  is  the  rapidity  and  difficulty  of  breathing.  Labored  breathing 
in  bronchitis  is  always  a  disagreeable  symptom,  and  when  this  is  com¬ 
bined  with  great  quickness,  and  with  perhaps  some  flushing  of  the 
face,  or  with  much  tendency  to  perspiration,  anxiety  should  always  be 
roused.  In  very  young  children  the  progress  of  bronchitis  is  some¬ 
times  exceptionally  rapid,  and  it  is  always  well  to  have  recourse  to 
medical  assistance  before  serious  symptoms  become  manifest,  and  in¬ 
deed  when  any  symptoms  of  illness  are  present  beyond  slight  cough 
and  occasional  wheezing.  The  continuance  of  feverishness  after  the 
first  day  of  illness  is  always  a  feature  calling  for  attention,  as  it  may  be 
the  only  apparent  indication  of  some  complication,  such  as  the  presence 
of  limited  areas  of  inflammation  of  the  lung. 

The  Treatment  of  Cold  must  be  divided  into  that  appropriate  to 
the  general  earlier  features,  and  that  applicable  to  the  individual  mani¬ 
festations.  When  a  child,  by  chilliness,  fretfulness,  and  slight  fever 
after  a  little  exposure,  shows  indications  of  having  taken  cold,  it 
should  be  placed  in  a  warm  bath  of  about  98°  F.,  allowed  to  remain  in 
it  from  five  to  ten  minutes,  then  taken  out  and  dried  carefully  in  a 
warm  room,  and  before  a  fire  if  the  weather  is  at  all  cold,  and  placed 
in  a  bed  previously  warmed.  WTien  in  bed  and  properly  covered,  some 
warm  drink  should  be  given,  such  as  gruel  or  infusion  of  jam,  or  even 
a  little  warm  wine  and  water.  On  the  following  morning  the  tem¬ 
perature  of  the  child  should  be  taken  with  the  clinical  thermometer 
before  it  is  allowed  to  rise  ;  and  if  the  thermometer  registers  a  tem¬ 
perature  above  99°  F.,  it  should  be  kept  in  bed  for  the  day.  The  diet 
should  be  made  as  light  as  possible,  consisting  mainly  of  milk,  bread 
and  milk,  farinaceous  puddings,  and  animal  broths  ;  and  the  child 
should  be  induced  to  drink  a  good  deal  of  fluid  in  the  form  of  milk, 
barley-water,  rice-water,  or  lemon  and  water  without  much  sugar.  If 
the  bowels  have  been  in  the  least  degree  confined,  their  action  should 
be  promoted  by  the  administration  of  some  sweet  essence  of  senna  or 
some  compound  licorice-powder.  When  the  cold  affects  only  the  head, 
very  little  bejmnd  this  general  treatment  is  required.  The  comfort  of 
the  nose  i&  promoted  by  occasionally  applying  to  it  a  sponge  squeezed 
out  of  hot  water  ;  after  which  it  should  be  dried  with  a  handkerchief, 
and  anointed  with  vaseline  [or  Magnetic  Ointment].  The  application 
of  vaseline  to  the  interior  of  the  nose  with  a  camel’s-hair  brush  is  also 
soothing,  and  comfort  is  sometimes  derived  from  inhaling  through  the 
nostrils  the  steam  arising  from  very  hot  water.  The  skin  of  the  upper 
lip  should  be  protected  from  irritation  arising  from  the  discharge  from 
the  nose  by  the  application  nightly  of  zinc  ointment  or  of  cold  cream. 

The  local  treatment  of  catarrhal  inflammation  of  the  throat  has 
been  already  described  under  Affections  of  the  Throat. 


234 


COMMON  MALADIES  OF  CHILDREN. 


Treatment  of  Cold  Affecting  the  Larynx. — When  the  larynx  is 

the  seat  of  inflammation,  the  frequent  inhalation  of  the  vapor  arising 
from  hot  water  is  of  much  value.  No  special  apparatus  is  required  for 
this,  as  an  ordinary  Lot-water  jug  answers  perfectly.  The  jug  should 
be  half  filled  with  water  almost  boiling,  and  the  head  held  a  few  inches 
above  the  mouth  of  the  jug  while  the  steam  is  inhaled.  If  a  large 
handkerchief  or  a  towel  is  thrown  over  the  head  and  gathered  round 
the  edge  of  the  jug,  the  steam  is  prevented  from  dissipating,  and  the 
inhalation  is  more  effective.  When  any  special  inhaler  is  employed, 
the  watei*  must  not  be  quite  so  warm  as  when  the  vapor  is  inhaled 
from  an  open  jug  ;  with  most  inhalers,  a  mixture  of  two  parts  of  boil¬ 
ing  water  to  one  part  of  cold  water  will  be  found  of  a  suitable  tem¬ 
perature.  In  these  cases  the  external  application  of  warm  linseed- 
meal  poultices,  or  weak  mustard-poultices,  is  very  grateful  and  soothing. 
The  poultice  should  be  tied  on  round  the  neck  so  as  to  cover  the  whole 
of  the  front  part,  and  should  be  changed  as  often  as  it  becomes  cool. 
[It  will  be  more  effective  if  well  covered  with  the  Magnetic  Ointment, 
so  that  this  comes  in  direct  contact  with  the  surface  of  the  skin.]  If  the 
cough  is  troublesome,  five  to  ten  drops  of  ipecacuanha  wine  may  be  given 
in  a  teaspoonful  of  glycerine  every  four  hours.  Spasmodic  attacks  of  so- 
called  false  croup,  which  occur  chiefly  during  the  night,  are  best 
treated  by  the  application  to  the  throat  of  a  large  sponge  squeezed  out 
of  hot  water,  followed  if  necessary  by  a  warm  bath  of  98°  F.  as  soon 
as  it  can  be  prepared.  The  inhalation  of  steam  is  also  most  useful. 
When  these  means  fail  in  arresting  the  attack,  which  very  seldom 
happens,  the  administration  of  an  emetic  in  the  form  of  one  or  two 
teaspoonfuls  of  ipecacuanha  wine  is  almost  invariably  successful. 

Treatment  of  Bronchitis. — Bronchitis  is  most  successfully  treat¬ 
ed,  when  slight,  by  the  application  once  or  twice  a  day  of  a  stimulating 
liniment  to  the  chest  and  back.  Eligible  liniments  for  very  young 
children  are  camphorated  oil  (liniment  of  camphor),  for  older  ones 
liniment  of  turpentine,  and  of  mustard.  [The  Magnetic  Ointment, 
with  its  combined  counter-irritant  and  soothing  properties  is  the  best 
local  remedy  for  young  or  old.] 

To  insure  the  efficacy  of  such  liniments  they  should  be  rubbed 
well  into  the  skin  of  the  chest  and  back  with  much  friction  of  the 
hand,  five  or  ten  minutes  or  even  longer  being  given  to  the  process. 
The  chest  should  then  be  covered  with  a  sheet  of  cotton-wool,  or  pro¬ 
tective  tissue  such  as  “  Gamgee  ”  tissue,  which  consists  of  a  layer  of 
cotton-wool  enclosed  within  two  layers  of  thin  gauze  ;  this  may  be 
maintained  in  position  by  one  or  two  turns  of  a  thin  flannel  bandage. 
When  the  cough  is  very  frequent  and  troublesome,  the  constant  applica¬ 
tion  of  linseed-meal  poultices  may  be  found  more  effective  in  allaying 
the  irritation.  These  should  be  applied  as  warm  as  can  be  borne,  both  to 


TREATMENT  OF  STOMACH  COLDS. 


235 

the  back  and  to  the  front  of  the  chest,  and  should  be  changed  as  often 
as  may  be  necessary  to  maintain  their  heat  continuously.  If  the  skin 
to  which  they  are  applied  becomes  tender  or  irritable,  a  little  olive-oil 
should  be  poured  over  the  surface  of  the  poultice  before  its  application  ; 
or  if  necessary  the  poultices  may  be  intermitted  for  some  hours,  while 
the  irritation  is  soothed  by  inunction  of  vaseline  or  olive-oil,  and  the 
chest  protected  by  cotton-wool  or  Gamgee  tissue.  The  most  useful 
internal  remedy  is  ipecacuanha  wine,  given  in  doses  of  from  five  to  ten 
drops  in  a  teaspoonful  of  glycerine  every  three  or  four  hours.  Very 
young  children  often  experience  much  difficulty  in  coughing  up  the 
mucus  which  collects  in  the  bronchial  tubes,  and  evidence  of  its  accumu¬ 
lation  there  is  afforded  by  sounds  of  rattling  and  bubbling  within  the 
chest.  In  such  cases  the' breathing  is  facilitated  and  the  cure  expedited 
by  the  administration  of  an  emetic,  in  the  form  of  one  or  two  teaspoon- 
luls  of  ipecacuanha  wine,  given  once  or  twice  in  twenty-four  hours  if 
necessary.  The  vomiting  thus  induced  causes  the  evacuation  from  the 
bronchial  tubes  of  most  of  the  mucus  accumulated  there,  and  also 
gets  rid  of  any  which  may  have  been  coughed  up  and  swallowed.  It 
has  already  been  remarked  how  little  discomfort  is  caused  to  young 
children  by  vomiting,  and  they  will  often  be  observed  looking  quite 
bright  and  happy  within  a  few  minutes  after  the  emetic  has  acted. 

In  all  cases  of  bronchitis  it  is  most  important  to  maintain  a 
proper  temperature  in  the  room  throughout  the  night.  Many  cases 
of  bronchitis  are  indefinitely  prolonged  by  neglect  of  this  precaution. 
A  temperature  of  at  least  G0°  F.  should  be  kept  up  in  all  cases  ;  some¬ 
times  even  a  nigher  one  of  from  64°  F.  to  66°  may  be  of  much  value. 

When  Cold  affects  the  Stomach  great  care  should  be  given  to 
the  diet  of  the  child,  which  should  consist  exclusively  of  milk,  light 
milk  puddings,  and  veal-tea  or  chicken-tea.  If  much  sickness  is  present 
it  may  be  necessary  to  abandon  the  milk  for  a  day  or  two,  and  to  give 
simply  veal-tea,  chicken-tea,  and  barley-water.  Great  relief  is  usually 
afforded  by  a  succession  of  mild  mustard-poultices  to  the  pit  of  the 
stomach,  the  poultices  being  made  of  such  a  strength  as  to  maintain 
some  degree  of  redness  of  the  skin.  Usually  a  strength  of  one  part  of 
mustard  to  five  or  six  parts  of  linseed-meal  will  suffice  to  effect  this. 
[The  Magnetic  Ointment  will  generally  be  found  preferable  to  mustard- 
poultices,  and  easier  to  manage.]  When  thirst  is  a  troublesome  symp¬ 
tom,  very  small  quantities  of  cold  water  or  barley-water  may  be  given 
as  often  as  desired,  not  more  than  from  one  to  two  teaspoonfuls  of  cold 
water,  or  twice  that  quantity  of  barley-water,  being  allowed  at  one 
draught.  As  the  pain  subsides,  greater  liberality  in  diet  may  be 
allowed,  the  child  returning  gradually  to  its  ordinary  diet  ;  but  for 
some  little  time  care  must  be  taken  to  prevent  the  ingestion  of  any¬ 
thing  at  all  likely  to  prove  difficult  of  digestion. 


COMMON  MALADIES  OF  CHILDREN. 


236 

If  Diarrhoea  is  present  fomentations  with  flannels,  wrung  out  of 
hot  water,  are  usually  more  agreeable  than  poultices,  as  they  are  lighter 
when  spread  over  a  large  surface.  Special  care  in  feeding  is  essential, 
and  often  complete  abstinence  from  all  food  except  chicken  or  veal 
tea,  and  barley-water,  for  twenty-four  hours,  will  result  in  complete 
cure.  When  a  cold  has  affected  either  the  stomach  or  bowels,  care 
should  be  taken  for  some  little  time  afterward  to  clothe  the  child 
warmly  ;  it  is  often  advisable  in  cold  weather  to  specially  protect  the 
abdomen  with  a  warm  flannel  binder. 

4.  Disorders  of  the  Digestive  Organs. — (a)  Acute  Indiges= 
tion. — Indigestion  in  children  occurs  both  as  an  acute  and  as  a  chronic 
affection.  In  its  acute  form  it  is  most  frequently  characterized  by  sen¬ 
sations  of  sickness,  vomiting,  headache,  and  occasional  pain  in  the  pit 
of  the  stomach,  without  any  marked  rise  of  temperature.  When  these 
symptoms  present  themselves,  the  absence  of  fever,  as  indicated  by  a 
normal  temperature,  is  of  much  importance,  as  many  acute  diseases 
begin  with  sickness  and  headache,  but  almost  always  exhibit  as  well  an 
increase  of  temperature.  When  the  attack  is  very  sudden,  and  has 
been  caused  by  the  ingestion  of  some  improper  article  of  food,  the 
offending  material  may  often  be  detected  in  the  vomited  matter. 

Acute  indigestion  is  probably  always  the  result  of  eating  improper 
food,  but  sometimes  the  symptoms  do  not  set  in  immediately  after  the 
food  has  been  taken,  so  that  it  is  occasionally  difficult  to  trace  the  cause. 
If  the  stomach  has  been  slightly  irritated  for  some  time  by  food  not 
easily  digested,  a  very  slight  cause  may  be  sufficient  to  initiate  a  severe 
attack  of  acute  indigestion.  In  very  young  children  the  attack  not  un- 
frequently  commences  with  convulsive  fits  ;  and  it  is  always  well  when 
such  fits  occur  in  children  to  inquire  carefully  what  articles  of  food 
they  have  recently  had,  as  a  clue  to  the  cause  of  the  fits  and  their 
treatment  is  often  thus  afforded. 

When  the  stomach  has  been  thoroughly  emptied  by  vomiting, 
there  results  usually  very  considerable  relief,  although  a  slight  sensa¬ 
tion  of  nausea  with  some  amount  of  headache  will  usually  remain,  dis¬ 
appearing  entirely  after  a  night’s  rest. 

In  a  less  acute  form  indigestion  presents  itself  in  the  form  of 
aching  pain  in  the  pit  of  the  stomach,  with  slight  feelings  of  nausea, 
some  disinclination  for  food,  perhaps  a  little  headache,  and  a  tendency 
to  lassitude  and  irritability  of  temper.  Many  children  are  very  prone 
to  attacks  of  this  kind,  which  are  caused  usually  by  some  unwonted 
article  of  food,  or  some  excess  in  quantity  ;  and  although  if  properly 
attended  to  they  are  of  short  duration,  and  of  comparatively  little  im¬ 
portance,  if  neglected  they  are  apt  to  lead  to  a  chronic  irritable  con- 
lition  of  the  stomach,  which  may  materially  impair  the  general  health. 

(b)  Chronic  Indigestion  is  of  rare  occurrence  in  children,  except 


INDIGESTION  ;  DIARRHOEA. 


237 


as  a  result  of  a  chronically  irritated  condition  of  the  lining  membrane 
of  the  stomach,  known  to  medical  men  as  chronic  gastric  catarrh. 
When  indications  are  noticed  in  a  child  of  gastric  disturbance  continu¬ 
ing  for  some  time,  in  the  form  of  want  of  appetite,  occasional  pain  in 
the  pit  of  the  stomach,  slight  headaches  affecting  chiefly  the  forehead, 
tendency  to  flushing  of  the  face  after  meals,  sudden  attacks  of  pallor, 
restlessness  at  night,  and  talking  in  the  sleep,  there  is  a  strong  prob¬ 
ability  of  the  existence  of  chronic  gastric  catarrh,  and  medical  advice 
should  be  sought.  The  cure  is  almost  always  rather  tedious,  and 
necessitates  much  attention  both  to  diet  and  to  climatic  conditions. 
[See  page  1226.] 

Treatment  of  Indigestion. — Acute  indigestion  usually  requires 
very  little  treatment.  If  the  stomach  is  not  thoroughly  evacuated  by 
vomiting,  an  emetic  of  one  or  two  teaspoonfuls  of  ipecacuanha  wine 
should  be  given  ;  or  sickness  may  be  produced  by  irritating  the  back  of 
the  throat  with  the  finger.  After  the  sickness  has  subsided,  some  laxa¬ 
tive  medicine  should  be  given,  to  remove  from  the  bowel  any  of  the 
irritating  material  which  may  have  lodged  there  ;  in  most  cases  the 
preferable  purgative  is  castor-oil,  given  in  a  dose  of  one  or  two  tea¬ 
spoonfuls,  according  to  the  age  of  the  child.  Complete  rest  should  be 
given  to  the  stomach  for  a  few  hours  afterward,  only  a  little  water 
or  barley-water  being  given  if  thirst  is  present ;  and  when  food  is 
again  allowed,  it  should  be  of  the  lightest  and  most  digestible  character. 

When  the  acute  indigestion  has  given  rise  to  convulsive  fits,  the 
child  should  be  placed  at  once  in  a  warm  bath,  and  whenever  an  arrest 
of  the  convulsions  takes  place,  efforts  should  be  made  to  induce  sick¬ 
ness  by  the  administration  of  ipecacuanha  wine,  or  by  tickling  the 
throat  with  the  finger  ;  after  which  a  large  enema  of  warm  water 
should  be  given,  and  the  child  then  allowed  to  remain  for  some  hours 
lying  in  warm  blankets,  and  without  any  food. 

The  treatment  of  chronic  indigestion  should  always  be  carried  out 
under  competent  medical  advice. 

(c)  Diarrhoea  in  children,  when  not  the  result  of  chill,  is  usually  due 
to  irritation  of  the  bowel  from  some  improper  food.  When  it  is  slight, 
it  may  bq  regarded  merely  as  a  somewhat  exaggerated  effort  of  the 
bowel  to  get  rid  of  obnoxious  contents,  and  should  not  be  interfered 
with.  It  is  apt,  however,  to  go  rather  beyond  what  is  necessary  for 
the  mere  discharge  of  the  offending  material,  and  to  continue  for  some 
time  after  it  has  been  expelled.  The  attention  to  be  given  to  diarrhoea 
depends  mainly  on  the  frequency  of  the  motions,  on  the  presence  or 
absence  of  pain,  and  on  the  duration  of  the  malady.  If  in  one  day  the 
number  of  motions  in  an  infant  exceeded  eight  or  ten,  or  in  a  child  of 
four  or  five  years  old  exceeded  six  or  eight,  it  would  generally  be 
desirable  to  resort  to  some  remediable  measures  ;  and  the  presence  of 


COMMON  MALADIES  OF  CHILDREN. 


238 

pain  of  a  colicky  character  would  more  urgently  call  for  them.  The 
continuance  of  such  frequency  of  action  for  forty-eight  hours  would 
undoubtedly  call  for  some  attention  ;  and  any  degree  of  frequency  be¬ 
yond  what  is  stated  above  continuing  for  two  days  in  an  infant  under 
one  year  old  would  arouse  some  amount  of  anxiety  ;  while  at  the  age  be¬ 
yond  that  it  would  be  followed  by  some  temporary  depression  of  health. 

The  Treatment  for  Diarrhoea  due  to  the  ingestion  of  improper 
food  consists  of  evacuation  of  the  offending  matter  as  rapidly  as 
possible  by  the  administration  of  one  dose  of  castor-oil  in  quantity 
suitable  to  the  age  of  the  child,  abstinence  for  a  day  from  all  food 
except  animal  broths  and  barley-water,  and,  in  the  case  of  young 
children,  rest  and  warmth  in  bed.  [Externally  apply,  without  rubbing, 
the  Magnetic  Ointment  ;  and  internally,  give  Magnetic  Cramp  Tablets. 
See  page  1228.] 

(d)  Prolapse  of  the  Bowel  not  unfrequently  occurs  in  children 
as  a  result  of  diarrhoea  of  some  duration  ;  sometimes,  on  the  other 
hand,  it  happens  as  a  consequence  of  persistent  constipation  In  both 
cases  it  is  directly  due  to  straining  on  the  part  of  the  child  in  order  to 
evacuate  the  bowels.  When  diarrhoea  has  continued  for  a  little  time, 
the  lower  end  of  the  bowel  becomes  irritable  and  swollen,  and  even 
when  the  bowel  has  been  completely  emptied,  a  sensation  is  experienced 
by  the  child  of  incomplete  evacuation  ;  it  accordingly  strains  with  the 
object  of  effecting  this  thoroughly,  and  as  a  result  the  somewhat 
swollen  bowel  projects  a  little  way  through  the  opening,  and  remains 
extruded  for  some  time.  The  everted  bowel  forms  a  purplish- red 
swelling,  varying  from  the  size  of  a  thimble  to  that  of  a  Tangerine 
orange,  at  the  opening  of  the  bowel,  and  is  readily  distinguished  from 
any  other  swelling  by  its  very  sudden  appearance,  and  by  the  presence 
of  an  opening  in  its  centre.  The  straining  which  constipation  occasion¬ 
ally  induces,  in  the  attempt  to  evacuate  the  bowel,  acts  in  a  very 
similar  manner  in  causing  prolapse.  In  all  cases,  probably,  the  lining 
of  the  bowel  near  the  opening  becomes  first  a  little  inflamed  and  swollen, 
and,  losing  its  elasticity,  lends  itself  more  easily  to  the  extrusion. 
When  prolapse  has  occurred  once  or  twice  under  circumstances  of 
irritation,  it  is  very  apt  to  happen  afterward  when  the  bowels  move  in 
a  normal  manner,  and  may  even  take  place  when  the  child  is  standing 
or  walking,  without  any  action  of  the  bowels.  It  gives  rise  to  some 
degree  of  discomfort,  which  may  speedily  increase  to  pain  unless  the 
prolapse  is  returned  into  the  bowel.  When  the  prolapse  is  slight,  it 
may  return  after  a  few  minutes  without  any  assistance,  but  as  a  rule  it 
is  necessary  to  aid  it  by  some  gentle  pressure  upward.  The  most  simple 
and  easy  method  of  returning  the  prolapsed  bowel  is  to  cover  the  little 
finger  with  one  fold  of  a  thin  towel  or  handkerchief  anointed  with  some 
vaseline  [or  Magnetic  Ointment],  and  to  push  the  point  of  the  finger, 


CONSTIPATION. 


239 


covered  by  the  towel,  into  the  opening  apparent  in  the  middle  of  the 
prolapsed  bowel.  If  the  finger  be  pushed  well  upward  the  bowel  will 
be  found  to  recede  within  the  opening  ;  and  when  it  has  regained  its 
proper  position  the  finger  should  be  drawn  carefully  from  inside  the 
covering  towel,  which  is  drawn  out  of  the  opening  gently,  after  re¬ 
moval  of  the  finger.  If  prolapse  occurs  frequently,  much  care  must 
be  taken  in  the  diet  of  the  child  to  prevent  either  diarrhoea  or  con¬ 
stipation,  and  the  child  must  be  watched-  during  evacuation  of  its 
bowels  in  order  that  no  unnecessary  straining  may  be  permitted.  When 
children  are  in  good  health  otherwise,  a  cold  bath  every  morning  is  of 
value  in  strengthening  the  lower  end  of  the  bowel,  and  obviating  the 
tendency  to  prolapse. 

(e)  Constipation  of  the  Bowels  consists  not  only  in  insufficient 
frequency  of  their  action,  but  also  in  an  abnormally  hardened  condition 
of  the  motions  on  evacuation.  The  normal  frequency  of  action  varies 
very  considerably  in  different  children,  as  it  does  at  various  ages.  In 
babies  under  six  months  old  the  bowels  usually  act  three  or  four  times 
daily  ;  between  six  months  and  a  year  from  two  to  three  times  ;  and 
between  one  and  two  years  old  about  twice  daily.  After  two  years  of 
age  one  motion  daily  is  the  most  usual,  but  some  children  have  regularly 
evacuations  twice  every  day,  and  even  three  may  occur  during  the  day 
without  any  apparent  deviation  from  health,  although  this  number  is 
very  uncommon.  On  the  other  hand,  some  children  have  only  one 
motion  every  second  day,  although  in  perfect  health.  Constipation 
may  be  considered  to  be  present  when  the  motions  are  abnormally  hard 
in  character,  and  occur  not  more  frequently  than  once  daily.  It  is  ex¬ 
ceptional,  however,  for  a  daily  motion  to  occur  regularly  when  the 
motions  are  unusually  hard  ;  generally  it  will  be  found  that  one  motion 
occurs  only  every  second  or  third  day.  One  reason  for  this  is  that  the 
passage  of  a  hard  motion  often  involves  some  discomfort  or  even  pain 
to  the  child,  and  it  accordingly  postpones  as  long  as  possible  the  effort 
to  evacuate  ;  another  reason  is  that  when  hardness  of  the  motions  has 
existed  for  some  little  time,  the  extremity  of  the  bowel  loses  its 
sensitiveness  to  indications  calling  for  relief,  and  the  healthy  evacua¬ 
tion  is  inadvertently  postponed.  These  two  reasons  afford  a  key  to 
part  of  the  treatment  necessary  for  constipation. 

Diet  in  Constipation. — The  existence  of  constipation  in  an  other¬ 
wise  healthy  child  is  generally  an  indication  of  the  necessity  of  some 
alteration  in  its  diet.  The  digestive  power  of  children  for  different 
articles  of  diet  varies  greatly,  and  a  diet  which  tends  to  Excite  diarrhoea 
in  some  may  be  insufficient  to  prevent  constipation  in  others.  It  is  not, 
therefore,  possible  to  indicate  any  definite  diet  which  will  insure  free¬ 
dom  from  constipation,  but  some  suggestions  may  be  offered  as  to  the 
direction  in  which  alterations  of  food  should  be  made. 


240 


COMMON  MALADIES  OF  CHILDREN. 


Not  unfrequently  a  diet  which  consists  too  exclusively  of  milk, 
and  foods  made  with  milk,  is  associated  with  constipation.  In  such 
cases  the  addition  of  some  animal  broths,  and  of  eggs  lightly  boiled  or 
poached,  may  be  of  much  value. 

When  only  light  and  prepared  farinaceous  foods,  or  the  prepared 
malted  ones  have  been  employed,  the  substitution  of  oatmeal  or  of 
Robinson’s  groats  may  facilitate  the  regular  action  of  the  bowels.  In 
young  children  any  change  of  food  should  be  made  with  caution,  and 
the  effect  watched.  When  children  have  reached  the  age  of  one  year, 
a  little  stewed  fruit,  such  as  prunes  or  apples,  maybe  added  to  the  diet, 
or  a  small  quantity  of  well-cooked  green  vegetables,  such  as  cauli¬ 
flower  or  spinach,  may  be  permitted.  The  addition  of  a  little  fat  to 
the  diet  in  the  form  of  cream,  butter,  or  a  little  fried  fat  bacon,  is 
often  very  useful  in  combating  the  constipation  of  the  bowels.  Cod- 
liver  oil  in  small  doses  is  often  used  for  this  purpose  with  much  advan¬ 
tage.  Sometimes  undue  dryness  of  diet  is  the  source  of  the  irregularity 
of  the  bowels.  The  child  perhaps  takes  some  farinaceous  food  for 
breakfast,  a  little  flsh  or  pudding  for  dinner,  and  again  something 
farinaceous  in  the  evening,  and  during  the  wdiole  day  drinks  no  fluid 
beyond  what  is  contained  in  the  food  supplied.  In  such  cases  the 
addition  of  fluid  to  the  diet  in  the  form  of  milk,  milk  and  water,  or 
plain  w^ater,  may  result  in  much  improvement.  In  older  children  the 
diet  must  be  varied  as  much  as  possible  consistently  with  the  digestive 
capabilities  of  the  child,  articles  of  diet  of  a  laxative  tendency  being 
selected,  such  as  oatmeal,  green  vegetables,  fruits,  both  cooked  and  un¬ 
cooked,  and  fats,  and  given  along  with,  or  in  place  of,  the  more  simple 
articles  of  food  appropriate  to  children’s  diet.  Much  assistance  in  the 
treatment  is  usually  effected  by  the  daily  administration  of  a  cold  bath, 
followed  by  friction  of  the  skin  with  a  warm  towel. 

Importance  of  Habit. — Of  very  great  importance  in  the  treat¬ 
ment  of  constipation  is  the  inculcation  of  a  habit  of  soliciting  an  action 
of  the  bowels  daily  at  a  fixed-  hour ,  and  devoting  at  least  five  minutes  to 
this  operation.  Reference  has  already  been  made  to  the  utility  of  this 
practice  in  inducing  regular  action  of  the  bowels,  and  its  importance 
is  emphasized  by  the  consideration,  mentioned  as  one  of  the  causes  of 
constipation,  that  the  hardness  of  the  motion  tends  to  cause  some 
insensibility  to  the  call  for  relief.  Mention  has  also  been  made  there  of 
the  tendency  of  children  to  postpone  the  evacuation  when  constipation 
exists,  on  account  of  the  discomfort  arising  from  the  hardness  of  the 
motions  ;  an  additional  reason  for  regularity  being  thus  afforded,  as  the 
hardness  and  consequent  discomfort  are  only  increased  by  the  delay, 
while  at  the  same  time  the  sensibility  of  the  bowel  is  diminished.  The 
sensibility  is  also  diminished  if  the  evacuation  is  only  incomplete,  and 
pare  should  be  taken  that  time  is  given  to  empty  the  bowel. 


REMEDIES  FOR  CONSTIPATION. 


241 


Enemas. — Wlien  alteration  of  diet,  together  with  regular  solicita¬ 
tion  of  action,  is  insufficient  to  relieve  altogether  the  constipation,  some 
assistance  must  he  afforded,  either  by  applying  locally  a  stimulus  to  the 
bowel,  or  by  the  administration  of  some  laxative  medicine.  The  most 
convenient  stimulus  to  the  bowel  for  this  purpose  is  afforded  by  the 
injection  of  one  or  two.  teaspoonfuls  of  glycerine  with  the  aid  of  a 
small  vulcanite  syringe,  such  as  is  described  in  Chapter  IY.  Usually 
within  five  or  ten  minutes  after  such  an  injection  the  bowels  act  freely 
and  effectively,  and  the  injection,  if  successful  in  its  action,  may  be 
repeated  daily,  or  better,  on  alternate  days,  without  any  risk  of  weaken¬ 
ing  or  injuring  the  bowel.  When  the  stimulus  of  the  glycerine  is  not 
sufficient  to  produce  adequate  action,  an  injection  of  three  or  four 
ounces  of  cold  writer  should.be  employed.  This  also,  like  the  injection 
of  glycerine,  may  be  repeated  when  necessary  without  fear  of  injury. 
It  is  generally  advantageous  to  repeat  such  injections  only  on  alternate 
days,  affording  the  bowel  an  opportunity  every  second  day  of  acting 
properly  without  artificial  stimulus. 

Laxative  Medicine. — When  it  is  found  that  even  with  daily  action 
of  the  bowel  induced  by  artificial  stimulus,  and  with  the  aid  afforded 
by  appropriate  alteration  of  diet,  the  motions  still  continue  to  be  of 
abnormal  hardness,  some  internal  medicine  must  be  resorted  to,  in 
order  to  modify  and  increase  the  secretion  from  the  lining  membrane 
of  the  bowrnl.  To  this  end  recourse  may  be  had  to  the  occasional 
administration  of  sweet  essence  of  senna,  compound  licorice  powder, 
or  sulphur  in  the  form  of  lozenges,  in  doses  suitable  to  the  age  of  the 
child.  It  should  always  be  borne  in  mind,  however,  that  the  employ¬ 
ment  of  drugs  for  this  purpose  should  be  resorted  to  as  seldom  as 
possible,  as  the  bowel  becomes  quickly  habituated  to  them,  and  the 
digestive  power  is  apt  to  be  weakened  by  their  frequent  use. 

5.  Non=Infectious  Eruptions  on  the  Skin. — Eruptions  of 
different  kinds  occur  frequently  in  children,  the  skin  during  the 
earlier  years  of  life  being  very  sensitive,  and  sympathizing  in  this  way 
with  various  disturbances  of  the  general  health.  Some  of  these  are 
associated  with,  and  apparently  dependent  upon,  some  disorder  of  the 
digestive  organs,  and  are  not  infectious  in  character  ;  others  form  the 
external  manifestations  of  what  are  known  as  essential  fevers,  and 
indicate  diseases  of  an  infectious  nature  ;  while  a  third  class  again  are 
due  to  irritation  of  the  skin  from  external  sources.  Some  of  the  more 
simple  non-infectious  eruptions  wdll  be  first  described. 

(a)  Heat=spots  ( Erythema  papulatum ). — These  spots,  although 
not  unfrequently  due  to  the  irritation  associated  with  dentition,  more 
frequently  result  from  some  disorder  of  digestion,  such  as  may  be  pro¬ 
duced  by  an  excess  of  animal  food  in  the  diet,  or  an  inordinate 
quantity  of  sugar.  Rarely  they  are  caused  by  flea-bites.  They  take 


242 


COMMON  MALADIES  OF  CHILDREN. 


the  form  of  disseminated  red  elevated  spots,  in  size  varying  from  a  split 
pea  to  a  threepenny  piece  [half  dime],  slightly  hard  to  touch,  irritable 
and  itching,  and  each  surrounded  by  a  small  circle  of  reddened  skin. 
Usually  they  occur  in  clusters,  but  sometimes  singly  ;  and  their  favorite 
sites  are  the  legs,  arms,  thighs,  back,  and  shoulders.  Their  appearance 
in  the  face  is  exceptional.  The  spots  usually  appear  suddenly  without 
any  warning  or  indication  of  illness,  remain  red  and  irritable  for  one 
or  two  days,  and  then  fade  and  disappear  gradually,  while  other  fresh 
ones  come  out  on  other  parts  of  the  body.  Successive  crops  may  con¬ 
tinue  in  this  way  for  several  weeks,  or,  in  fact,  so  long  as  the  disturb¬ 
ing  disorder  of  digestion  persists.  When  the  eruption  is  severe,  some 
of  the  spots  occasionally  have  a  small  vesicle  of  fluid  on  their  apex, 
which  dries  up  as  the  spots  subside.  The  recognition  of  heat-spots  is 
not  usually  difficult,  as  their  appearance  is  almost  characteristic.  The 
one  disease  for  which  sometimes  they  are  mistaken  is  chicken-pox,  and 
then  only  when  the  small  vesicles  on  the  apex  of  the  spots  are  excep¬ 
tionally  apparent.  The  points  of  distinction  are  that  in  heat-spots  the 
elevated  red  spots  are  large  and  somewhat  hard  and  any  vesicles  pres¬ 
ent  very  small,  wdiile  in  chicken-pox  some  of  the  vesicles  are  usually 
rather  large,  the  surrounding  redness  very  small,  or  even  absent 
altogether,  and  the  hardness  entirely  absent  ;  that  heat-spots  generally 
occur  in  clusters,  and  are  often  limited  to  one  arm  or  one  leg  or  other 
situation  on  the  body,  while  the  vesicles  of  chicken-pox  are  always 
disseminated  over  the  whole  body,  including  as  a  rule  a  few  on  the 
face  ;  and  that  the  vesicles  of  heat-spots  when  present  tend  to  shrivel 
and  disappear  within  twenty-four  hours,  while  those  of  chicken-pox 
usually  increase  in  size  for  one  or  two  days.  It  is  only  indeed  within 
the  first  twenty-four  hours  of  their  appearance  that  any  mistake  can  be 
made,  and  the  most  common  error  is  in  mistaking  chicken-pox  at  its 
commencement  for  heat-spots  than  the  converse.  Further  points  of 
distinction  in  this  early  stage  will  be  given  when  chicken-pox  is 
described. 

The  Treatment  of  Heat=Spots  should  be  directed  to  the  removal 
of  the  disturbance  to  which  their  appearance  is  due.  If  the  irritation 
of  teething  appears  to  be  the  cause,  attention  should  be  paid  to  the 
condition  of  the  mouth,  and  mild  laxative  medicines,  such  as  sweet 
essence  of  senna,  or  fluid  magnesia,  should  be  given,  as  suggested  in 
the  chapter  on  Disorders  connected  with  Dentition.  When  the  diges¬ 
tion  appears  in  fault,  which  may  be  assumed  to  be  the  case  in  the 
absence  of  any  disturbance  due  to  teething,  any  apparent  error  in  diet 
must  be  corrected,  the  frequent  association  of  the  heat-spots  with  a 
rich  meat  diet,  with  “heating”  (highly  nitrogenous)  articles  of  food 
such  as  oatmeal,  and  with  excess  of  sugar,  being  specially  kept  in  view. 
In  addition  to  alteration,  and  occasionally  reduction  in  quantity,  of 


ROSEOLA  OR  ROSE-RASH. 


243 


diet,  it  is  generally  well  to  act  on  the  bowels  slightly  by  giving  a  mild 
aperient  every  second  night,  fluid  magnesia  in  appropriate  doses  being 
eligible  in  such  circumstances.  The  most  soothing  local  applications 
for  the  irritation  of  the  spots,  which  is  apt  to  be  especially  trouble¬ 
some  at  night,  are  vaseline,  cold  cream,  and  Goulard  water  mixed  with 
milk  in  equal  portions. 

(b)  Roseola  or  Rose=rash  is  an  affection  of  the  skin  of  very 
slight  importance,  and  usually  of  very  temporary  duration,  due  to 
some  slight  disturbance  of  the  digestive  system.  It  occurs  in  the  form 
of  a  rose-colored  rash,  covering  sometimes  the  whole,  sometimes  only  a 
part,  of  the  body,  which  on  careful  examination  is  seen  to  be  made  up 
of  innumerable  small  crimson  spots,  separated  from  each  other  by 
narrow  intervals  of  healthily  colored  skin.  The  spots  vary  in  size  con¬ 
siderably  in  different  cases,  sometimes  being  very  little  larger  than  a 
large  pin’s  head,  at  other  times  attaining  a  size  larger  than  a  split  pea. 
The  intervals  of  healthy  skin  differ  in  size  also,  sometimes  being  so  small 
that  the  eruption  presents  on  superficial  examination  the  appearance  of 
uniform  flushing  of  the  skin,  the  individual  spots  only  becoming  fully 
apparent  on  more  careful  observation  ;  while  in  other  cases  each  spot 
is  very  distinctly  surrounded  with  an  area  of  normal  color.  The 
eruption  is  accompanied  by  very  little  or  no  rise  of  temperature,  but 
there  are  usually  some  signs  of  disordered  digestion  in  the  form  of  sen¬ 
sations  of  nausea,  disinclination  for  food,  and  slightly  coated  tongue. 
As  a  rule,  it  continues  for  one  or  perhaps  two  days,  disappearing  some¬ 
times  somewhat  suddenly,  in  other  cases  more  gradually. 

Rose-rash  is  noteworthy  mainly  on  account  of  its  liability  to  be 
confounded  with  measles  on  the  one  hand,  and  with  scarlet  fever  on 
the  other.  When  the  spots  are  large  and  distinctly  separated,  they 
resemble  very  closely  the  eruption  of  measles  ;  when  very  small  and 
closely  aggregated,  the  resemblance  to  scarlet  fever  is  equally  striking. 
The  differential  diagnosis  lias  therefore  to  rest  chiefly  on  other  points 
than  the  appearance  of  the  eruption,  although  slight  differences  in 
color  afford  sometimes  a  distinction  of  some  value. 

•  The  distinction  from  measles  is  made  chiefly  by  the  occurrence  of 
the  eruption  in  roseola  without  any  preliminary  symptoms  of  illness, 
the  absence  of  fever,  and  of  watering  of  the  eyes,  cold  in  the  head,  and 
cough,  such  as  arc  usually  present  at  the  commencement  of  measles, 
and  the  altogether  slighter  character  of  the  illness.  In  measles  also  the 
eruption  is  nearly  always  most  developed  on  the  face,  where  it  appears 
first,  spreading  from  there  downward  over  the  whole  body  ;  in  roseola 
it  does  not  always  cover  the  whole  body,  and  is  seldom  well  marked  on 
the  face,  being  most  distinct  usually  on  the  chest  or  abdomen.  These 
distinctive  points,  together  with  the  fact  that  isolated  cases  of  measles 
are  rare,  the  disease  commonly  occurring  in  epidemics,  are  usually 


244 


COMMON  MALADIES  OF  CHILDREN. 


sufficient  to  make  the  differentiation  between  rose-rash  and  measles 
easy.  It  is  much  more  difficult,  when  roseola  assumes  the  form  of 
eruption  similar  to  scarlet  fever,  to  distinguish  it  from  slight  cases  of 
that  very  infectious  disease.  The  color  of  the  eruption  sometimes  aids  : 
in  roseola  it  is  of  a  crimson  or  rose  color  usually,  while  in  scarlet  fever 
it  is  distinctly  scarlet.  These  shades,  however,  tend  to  approximate, 
and  it  is  sometimes  very  difficult,  in  either  of  the  diseases,  to  say 
whether  a  particular  eruption  should  be  called  crimson  or  scarlet. 
When  the  individual  shade  is  distinctly  marked,  however,  it  is  of  con¬ 
siderable  value  as  a  differential  sign.  In  roseola  there  is  very  seldom 
any  tenderness  of  the  throat  complained  of,  although  sometimes  it  may 
be  slightly  reddened  ;  in  scarlet  fever  there  is  generally  some  sense  of 
dryness  of  the  throat  and  discomfort  in  swallowing.  The  presence  of 
much  fever,  and  especially  its  duration  for  more  than  twenty -four 
hours,  is  strong  evidence  in  favor  of  scarlet  fever.  Marked  flushing 
of  the  face  also  points  strongly  to  scarlet  fever,  and  a  somewhat  dry 
injected  condition  of  the  white  part  of  the  eyes  is  very  characteristic 
of  that  disease.  The  eruption  of  scarlet  fever,  like  that  of  roseola,  is 
not  unfrequently  partial,  and  most  marked  upon  the  chest  rather  than 
the  face  ;  but  a  valuable  point  of  distinction,  when  present,  is  found 
in  the  fact  that  the  eruption  of  scarlet  fever,  even  when  faint  in  other 
parts  of  the  body,  is  often  well  marked  in  front  of  the  elbow  and  fore¬ 
arm  and  behind  the  knees,  while  roseola  is  very  seldom  or  never  well 
marked  on  the  limbs  without  appearing  distinctly  also  on  the  body. 
In  some  cases  the  difficulty  of  distinction  at  first  sight  is  insurmount¬ 
able,  and  observation  of  the  progress  of  the  illness  for  twenty-four  or 
forty-eight  hours  is  necessary  in  order  to  arrive  at  a  certain  diagnosis. 
If  the  disease  be  scarlet  fever,  the  fact  is  then  usually  made  sufficiently 
apparent  by  the  persistence  of  fever,  the  increase  of  discomfort  of  the 
throat,  and  the  duration  of  the  eruption. 

Roseola  calls  for  very  little  treatment.  If  no  fever  exists,  it  is  not 
necessary  to  confine  the  child  to  bed,  but  its  diet  should  be  regulated 
carefully,  only  light  and  easily  digested  food  being  allowed,  and  some 
slight  aperient,  such  as  effervescing  citrate  of  magnesia  or  sweet  essence 
of  senna,  should  be  given.  If  there  is  any  suspicion  that  the  disease 
may  be  scarlet  fever,  and  not  roseola,  the  child  should  be  rigidly 
isolated  from  others  until  a  positive  diagnosis  is  arrived  at. 

(c)  Nettle=rash  ( urticaria )  is  another  affection  of  the  skin,  which 
although  very  troublesome  and  Irritating,  is  of  no  serious  importance 
regarded  from  the  view  of  the  general  health  of  the  child.  It  is 
usually  of  very  temporary  duration,  but  is  somewhat  apt  to  reappear 
at  intervals,  for  two  or  three  days  after  it  has  first  manifested  itself. 
It  is  generally  due  to  the  ingestion  of  some  article  of  food  which  may 
not  be  in  the  least  degree  difficult  of  digestion  by  most  children,  but 


URTICARIA  OR  NETTLE-RASH. 


245 


which  in  some  way  is  especially  irritating  to  the  individual  child 
affected.  Among  articles  of  food  specially  prone  to  excite  nettle-rash 
in  some  children  are  various  shell-fish,  such  as  oysters,  mussels,  crabs, 
and  lobsters  ;  some  fruits,  especially  perhaps  strawberries  ;  cured  meats, 
including  sausages  and  smoked  tongue  ;  and  fresh  pork.  Some  chil¬ 
dren  are  very  liable  to  nettle-rash,  in  some  cases  probably  having  a 
hereditary  tendency  to  it,  and  suffer  from  an  attack  whenever  the 
stomach  is  at  all  disordered  by  their  having  eaten  some  indigestible 
food.  The  eruption,  which  may  be  generally  distributed  over  the  body 
and  face,  but  which  is  more  usually  very  partial,  often  affecting  only  a 
very  limited  area,  takes  the  form  of  irregularly  shaped  red  blotches, 
somewhat  elevated  from  the  surrounding  skin,  and  usually  surmounted 
by  a  patch  of  exceptionally  white  skin,  technically  known  as  a  “wheal.” 
The  blotches  resemble  closely  in  appearance  those  produced  on  the  skin 
by  contact  with  the  common  stinging  nettle.  Occasionally  the  white 
patch  in  the  centre  is  absent,  but  usually,  on  careful  inspection,  a  small 
area  of  somewhat  paler  color  can  be  detected  in  the  centre  of  the  red 
blotch.  The  blotches  seldom  occur  singly,  more  generally  being 
associated  in  clusters  ;  and  individually  may  vary  in  size  from  a  shilling 
to  a  five-shilling  piece  or  more.  Their  outline  is  generally  irregular, 
the  edges  being  indented,  and  frequently  a  narrow  prolongation  of  the 
central  wheal  runs  along  the  centre  of  each  indentation.  When  the 
eruption  appears  on  the  face,  the  eyelids  may  be  so  much  swollen  as  to 
almost  close  the  eyes,  the  nose  and  lips  appear  enlarged,  and  the  face 
generally  has  the  aspect  of  being  affected  with  erysipelas.  Sometimes 
the  tongue  and  interior  of  the  mouth  are  also  attacked  with  the  affec¬ 
tion,  becoming  swollen  and  discolored.  The  change  in  appearance  of 
the  skin  is  accompanied  by  a  sensation  of  tingling  and  itching  of  a 
very  intolerable  character,  which  gives  rise  to  much  restlessness,  and 
to  efforts  to  seek  relief  by  scratching.  The  most  marked  feature  of 
the  malady  is  the  suddenness  with  which  it  may  disappear  from  one 
part  of  the  body,  without  leaving  any  trace  behind,  and  reappear  in 
another  part  immediately  in  an  equally  acute  form  ;  or  depart  al¬ 
together,  leaving  the  skin  in  an  apparently  absolutely  healthy  condition. 

The  characteristic  feature  of  nettle-rash  arc  so  peculiar  that  it  can 
scarcely  be  mistaken  for  any  other  disease,  except  in  the  rather  un¬ 
usual  instances  where  the  eruption  is  so  general  over  the  whole  body 
that  the  blotches  merge  in  each  other,  and  no  distinct  wheals  appear 
in  the  centre  of  individual  blotches.  In  such  cases  the  disease  at  first 
sight  presents  superficially  the  appearance  of  scarlet  fever ;  but  the 
extreme  suddenness  of  the  onset,  the  absence  of  fever,  and  the  presence 
of  distinct  tingling  and  itching  usually  make  the  character  of  the  dis¬ 
ease  apparent.  In  general,  also,  a  careful  inspection  will  bring  to  light 
some  part  of  the  body  where  the  eruption  shows  a  limit,  characterized 


246 


ECZEMA. 


by  an  irregular  outline  and  perhaps  by  a  slight  wheal,  indicating  with 
absolute  certainty  the  nature  of  the  affection. 

The  Treatment  of  Nettle=rash  is  very  simple.  If  the  article  of 
diet  to  which  its  appearance  may  be  attributed  has  been  very  recently 
ingested,  an  emetic  of  one  or  two  teaspoonfuls  of  ipecacuanha  wine, 
or  better,  of  a  teaspoonful  of  mustard  in  half  a  tumbler  of  warm 
water,  should  be  given,  followed  as  soon  as  convenient  with  a  dose  of 
castor-oil.  If  one  or  two  hours  have  elapsed  since  the  ingestion  of  the 
food,  the  castor-oil  should  be  administered  without  a  previous  emetic. 
When  the  eruption  tends  to  recur  after  the  bowels  have  been  well  acted 
on,  abstinence  from  meat  diet  for  a  day  or  two,  with  two  or  three  doses 
daily  of  fluid  magnesia  or  effervescing  citrate  of  magnesia,  will  in  a 
few  days  generally  effect  a  complete  cure. 

(d)  Eczema,  in  a  slight  form,  is  a  frequent  malady  of  children, 
and  is  probably  generally  the  result  of  a  tendency  inherited  from  the 
parents  or  more  remote  ancestors,  and  developed  by  the  irritation  of 
dentition,  by  inappropriate  diet,  or  by  residence  on  an  unsuitable  soil, 
or  in  a  climate  favorable  to  its  manifestation.  Children  predisposed 
to  eczema  will  often  exhibit  'it  during  the  cutting  of  almost  every  in¬ 
dividual  tooth  ;  and  after  dentition  is  completed,  the  eruption  may 
recur  at  any  time  that  the  health  is  slightly  depressed,  or  the  digestive 
organs  in  any  way  irritated.  The  most  usual  sites  for  the  appearance 
of  slight  eczema  are  the  flexures  of  the  knees  and  elbows  ;  more  rarely 
the  folds  of  the  groins,  and  the  scalp  of  the  head.  In  addition  to 
these  parts,  it  may  present  itself  in  patches  on  any  other  situation  of 
the  body.  When  first  affected  with  slight  eczema  the  skin  appears 
somewhat  reddened,  and  a  little  more  dry  than  usual,  with  a  slight 
tendency  to  throw  off  small  glistening  scales.  This  appearance  is 
accompanied  by  some  itching,  which  is  apt  to  be  especially  trouble¬ 
some  during  the  night,  frequently  inducing  the  child  to  scratch  to  such 
an  extent  as  to  produce  slight  bleeding.  The  patches  have  usually 
very  little  tendency  to  extend  in  size.  The  brightness  of  their  color 
varies  much  from  day  to  day,  the  irritation  which  they  produce  vary¬ 
ing  to  some  extent  with  the  vividness  of  their  tint.  As  the  acuteness 
of  the  eczema  increases,  the  skin  breaks  in  small  cracks,  from  which  a 
little  fluid  exudes,  giving  the  surface  a  somewhat  moist  appearance  ; 
and  with  the  increase  of  the  moisture  the  small  scales  disappear,  and 
the  whole  surface  assumes  a  raw  and  superficially  ulcerated  aspect. 
The  variations  in  appearance  from  day  to  day  are  usually  noticeable. 

Sometimes  eczema  occurs  in  a  much  milder  form,  producing  hardly 
any  discoloration  of  the  skin,  and  presenting  itself  simply  as  a  some¬ 
what  dry  and  roughened  patch  on  the  skin,  with  a  little  exfoliation  of 
very  small,  dry,  glistening  scales,  never  becoming  so  acute  as  to  assume 
a  reddened  color,  or  to  give  rise  to  itching  or  irritation. 


/ 


COMMON  MALADIES  OF  CHILDREN. 


247 


As  a  rule,  there  is  do  difficulty  in  diagnosing  the  nature  of  the 
malady.  Its  favorite  sites,  in  the  angles  of  the  joints  and  on  the  scalp, 
the  reddened  and  scaly  or  moist  appearance,  the  frecpjent  variation  of 
intensity,  and  the  irritation  markedly  increased  during  the  night,  are 
quite  characteristic  of  eczema.  The  duration  of  the  disease  is  indefinite. 
It  may  last  days,  or  weeks,  or  months,  or  years,  sometimes  giving  rise 
to  much  annoyance,  at  other  times  subsiding  to  such  an  extent  as  to 
excite  not  the  least  discomfort.  Its  treatment  often  calls  for  consider¬ 
able  care,  patience,  and  judgment ;  and  when  the  disease  persists,  re¬ 
course  should  always  be  had  to  medical  advice,  as,  although  no  risk  to 
life  is  involved,  the  irritation  and  disturbance  arising  from  its  presence 
may  very  seriously  affect  the  general  health  of  the  sufferer. 

Treatment  of  Eczema. — On  its  first  appearance  attention  should 
be  paid  to  the  condition  of  the  digestion.  The  diet  should  be  made  as 
simple  as  possible,  any  excess  of  meat  being  avoided,  and  sugar  being 
given  as  sparingly  as  possible.  If  the  action  of  the  bowels  is  sluggish, 
it  should  be  promoted  by  some  mild  aperient  given  every  second  night, 
the  most  eligible  being  compound  licorice  powder.  If  the  eczema  is 
associated  with  irritation  from  teething,  aperients  are  specially  called 
for,  and  may  be  given  when  necessary  every  night  for  three  or  four 
nights  in  succession.  To  subdue  the  heat  and  itching  some  soothing  oint¬ 
ment,  spread  on  lint  or  linen,  should  be  applied  to  the  patches  throughout 
the  night  ;  and,  so  far  as  possible,  the  child  should  be  prevented  from 
scratching.  A  very  convenient  ointment  for  allaying  irritation  is 
formed  by  the  mixture  in  equal  parts  of  zinc  ointment  and  Carron  oil. 
[The  Magnetic  Ointment  is  often  useful  in  such  cases.  Try  it.] 

6.  Infectious  Eruptive  Fevers. — The  second  class  of  eruptions 
referred  to  above  includes  those  associated  with  and  characteristic  of 
some  infectious  fevers.  Infectious  eruptive  fevers  are  characterized  by 
certain  peculiar  features,  which  are  common  to  them  all,  and  which 
serve  to  distinguish  them  from  other  forms  of  disease.  The  first  and 
most  important  of  these  is  their  communicability  from  one  person  to 
another,  a  property  indicated  in  the  title  of  “  infectious  ”  applied  to 
them.  The  infective  material  which  is  the  vehicle  of  conveyance  has 
been  shown  within  recent  years  to  consist  of  germs  of  minute  micro¬ 
scopic  size,  possessing  to  some  extent  individual  life,  and  capable  of 
being  cultivated  and  studied  in  various  media,  such  as  gelatine  or  beef 
jelly,  outside  and  apart  from  the  human  body.  Usually  those  infection- 
bearing  germs  are  transferred  from  the  person  suffering  from  the  in¬ 
fectious  fever  to  others  by  actual  contact  or  by  close  approximation, 
but  they  may  be  conveyed  for  considerable  distances  in  clothes,  books, 
foods,  and  other  articles  ;  and  when  circumstances  are  favorable  to 
the  life  of  the  germs,  as  when  accidentally  adhering  to  clothing  laid 
aside  in  a  drawer,  without  exposure  to  fresh  air,  or  when  enclosed  in 


ERUPTIVE  FEVERS. 


248 

an  envelope,  they  may  retain  tlieir  infections  powers  for  many  months. 
When  any  infectious  germs  obtain  admission  to  milk,  they  multiply 
with  great  rapidity,  contaminating  the  whole  supply  of  milk  to  which 
they  have  had  access,  and  rendering  it  an  infection-bearing  fluid  of 
much  activity.  Many  severe  epidemics  of  scarlet  fever,  especially, 
have  owed  their  origin  to  the  accidental  distribution  of  milk  contami¬ 
nated  with  the  germs  of  that  disease.  To  some  extent  the  same  thing 
occurs  when  impure  water  is  exposed  to  contamination. 

These  germs  are  present  in,  and  are  probably  thrown  off  into  the 
surrounding  atmosphere  from  the  skin  and  lungs  of  every  person  suffer¬ 
ing  from  an  infectious  fever,  from  the  commencement  until  the  ter¬ 
mination  ;  but  at  different  periods  in  different  illnesses  they  seem  to 
exist  either  in  greater  number  or  in  more  virulent  form,  as  infectious 
diseases  are  found  to  vary  in  their  infectious  powers  at  different  stages 
of  their  progress.  How  is  it,  then,  it  may  be  asked,  that  so  many 
persons  who  come  into  intimate  association  with  infectious  diseases 
escape  the  infection  ?  The  answer  is  that  probably  every  person  has 
some  power  of  resisting  the  attacks  of  infectious  germs,  this  power  of 
resistance  varying  much  in  different  people,  and  in  different  states  of 
health  in  the  same  person.  The  length  of  exposure  to  the  attacks  of 
the  germs  is  also  in  some  cases  a  factor  in  determining  the  success  or 
failure  of  the  attack.  It  is  frequently  observed  that  doctors  com¬ 
paratively  seldom  acquire  infectious  illnesses  from  their  patients,  their 
visits  lasting  only  a  short  time,  while  nurses  are  specially  prone  to  fall 
victims,  unless  protected  by  previous  attacks  of  the  same  disease. 

The  germs  of  infectious  fevers  all  lose  their  power  rapidly  when 
exposed  to  the  open  air,  and  to  the  rays  of  the  sun.  It  is  very  seldom, 
indeed,  that  infection  is  conveyed  by  means  of  the  air  alone  farther 
than  a  limited  number  of  feet  from  the  bed  of  the  patient,  except, 
perhaps,  in  the  case  of  small-pox,  the  germs  of  which,  some  think, 
may  be  carried  some  hundred  yards  without  losing  their  infectious 
property.  In  almost  all  cases  where  infection  has  been  carried  for 
some  distance  from  a  patient,  it  will  be  found  on  careful  inquiry  that 
some  material  vehicle  has  conveyed  the  poison  ;  it  may  be  a  letter  or 
newspaper,  a  book,  a  parcel,  or  an  article  of  dress  worn  by  someone 
who  has  been  in  communication  with  the  invalid. 

Infectious  germs  can  also  be  destroyed  with  facility  by  artificial 
means.  Exposure  for  about  two  hours  to  dry  heat  in  an  oven,  or  to 
moist  heat  in  the  form  of  steam  in  a  boiler,  effects  their  destruction  if 
the  temperature  exceeds  200°  F. ;  and  boiling  also  for  twenty  minutes 
to  half  an  hour  is  thoroughly  effective  in  destroying  them.  Various 
disinfectants  also,  among  which  carbolic  acid,  permanganate  of  potash 
(Condy’s  fluid),  and  chloride  of  lime  are  specially  worthy  of  mention, 
are  reliable  as  destructive  agents  of  infectious  germs,  when  employed 


CHICKEN-POX. 


249 

with  proper  care  and  in  suitable  strength.  Some  directions  for  their 
employment  are  given  in  Chapter  XVI. 

It  has  to  be  remarked  that  no  satisfactory  method  has  yet  been 
discovered  of  arresting  the  infectious  germs  before  they  leave  the 
patient,  which,  were  it  possible,  would  be  the  most  thorough  way  of 
preventing  any  extension  of  infection.  Efforts  in  this  direction  are 
made  by  anointing  the  skin  with '  disinfectant  ointments,  but  though 
the  excretion  of  germs  from  the  skin  may  be  thus  prevented,  they 
make  their  escape  by  the  breath,  as  well  as  in  other  excretions  ;  and  it 
is  impossible  to  saturate  the  air  with  any  disinfectant  sufficiently  to 
destroy  the  germs,  without  at  the  same  time  rendering  it  dangerous  of 
respiration  to  the  patient. 

Stages  of  Infective  Fevers. — Another  peculiarity  of  infectious 
eruptive  fevers  is  that  all  run  a  definite,  and  to  a  considerable  extent 
similar  course,  which  is  characterized  by  four  distinct  stages,  easily 
recognizable  in  each  individual  disease.  The  duration  of  these  stages 
varies  in  the  different  forms  of  eruptive  fevers,  but  is  fairly  constant 
for  each  special  fever.  They  are  known  as  the  stages  respectively  of 
incubation,  of  invasion,  of  eruption,  and  of  desquamation. 

The  Stage  of  Incubation  is  that  period  which  elapses  between  the 
reception  of  infection  and  the  manifestation  of  any  active  symptoms  of 
illness.  Usually  for  some  days  after  the  contraction  of  infection  no  dis¬ 
comfort  or  sense  of  illness  is  experienced,  and  although  sometimes  a 
slight  sense  of  malaise  and  physical  depression  may  be  present  for  a 
day  or  two  before  the  commencement  of  the  stage  of  invasion,  more 
commonly  the  beginning  of  that  stage  is  the  first  indication  of  illness. 

The  Stage  of  Invasion  occupies  the  period  from  the  manifestation 
of  the  first  definite  symptoms  of  illness  to  the  commencement  of  the 
appearance  of  the  eruption. 

The  Stage  of  Eruption  extends  from  the  time  when  the  eruption 
first  appears  to  its  disappearance,  and  is  followed  by — 

The  Stage  of  Desquamation,  which  usually  continues  until  con¬ 
valescence  is  established. 

The  approximate  duration  of  these  stages  in  different  fevers  will 
be  mentioned  when  the  individual  diseases  are  described. 

A  further  peculiarity  of  these  eruptive  fevers  is  that  one  attack  of 
any  of  them  in  a  great  measure  protects  during  the  whole  of  life  from 
a  second  attack  of  the  same  disease.  The  protection  is  not  absolute, 
as  every  one  of  them  has  been  known  to  occur  twice  or  even  three 
times  in  the  lifetime  of  an  individual,  but  such  second  attacks  are  so 
unusual  that  the  risk  of  them  may  be  practically  disregarded. 

(a)  Chicken=pox  ( varicella )  is  the  mildest  of  the  eruptive  fevers. 
Its  period  of  incubation  is  long,  varying  usually  from  twelve  to  nine¬ 
teen  days.  On  the  other  hand,  the  stage  of  invasion  is  very  short,  not 


\ 


250 


COMMON  MALADIES  OF  CHILDREN. 


exceeding  twelve  to  twenty-four  hours  ;  and  is  often  of  so  exceedingly 
mild  a  character  that  it  is  overlooked  altogether,  and  the  active  symp¬ 
toms  appear  to  commence  with  the  eruptive  stage.  When  any  symp¬ 
toms  are  noticeable  in  the  stage  of  invasion,  they  seldom  amount  to 
more  than  slight  headache,  want  of  appetite,  perhaps  a  sensation  of 
nausea,  or  even,  in  young  children,  some  vomiting,  and  a  slight  rise  of 
temperature  seldom  exceeding  one  or  two  degrees.  The  eruption  ap¬ 
pears  in  the  form  of  some  small  red  spots  distributed  at  wide  intervals 
over  the  body  and  face,  which  within  a  few  hours  change  into  small 
watery  vesicles  each  surrounded  by  a  faint  pink  ring.  The  change 
from  spots  to  vesicles  is  often  so  rapid  that  the  vesicles  are  often  con¬ 
sidered  to  be  the  original  form  of  the  eruption  ;  but  careful  inspection 
will  usually  show  some  spots  which  have  not  undergone  alteration. 
The  vesicles  are  often  found  to  vary  in  size  considerably  on  different 
parts  of  the  skin,  some  remaining  not  larger  than  a  pin’s  head,  others 
increasing  in  size  within  twenty-four  hours  until  they  measure  about  a 
quarter  of  an  inch  in  diameter.  They  are  scattered  irregularly  over 
the  whole  body,  face,  and  head,  and  never  occur  in  isolated  clusters, 
like  the  heat-spots  described  at  the  beginning  of  the  chapter.  The 
number  of  vesicles  varies  greatly,  sometimes  only  a  very  few,  perhaps 
ten  or  twenty,  being  noticed  ;  at  other  times  two  or  three  hundred  are 
distributed  over  the  skin.  Fresh  crops  are  usually  thrown  out  for  two 
or  three  days  after  the  first  appearance  of  the  eruption,  and  some  of 
the  old  vesicles  continue  their  increase  in  size,  never  however  much 
exceeding  a  quarter  of  an  inch  in  diameter.  About  the  third  or  fourth 
day  from  the  commencement  of  the  eruption  it  attains  its  height,  and 
the  vesicles,  varied  in  size,  appear  as  small  globular  or  ovoid  blisters, 
glistening  and  opalescent,  and  each  surrounded  with  a  faint  pink  circle 
of  skin.  After  this  they  lose  somewhat  their  shining  appearance,  be¬ 
coming  of  a  dim  white  or  yellow  or  brownish  shade,  and  dry  up 
gradually  into  dry  brown  scabs,  which  usually  fall  off  the  skin  in  from 
ten  to  twelve  days  from  the  first  commencement  of  the  eruption.  This 
falling  off  of  the  scabs  constitutes  the  desquamative  stage  of  the 
disease.  Usually  on  the  first  falling  off  of  a  scab,  a  very  minute 
cicatricial  scar  can  be  observed  on  the  skin  underneath  ;  this,  however, 
almost  invariably  disappears  after  a  week  or  two.  Very  rarely  indeed 
is  a  permanent  little  scar,  like  one  of  the  depressions  due  to  small-pox, 
left  behind  ;  when  it  happens  it  is  usually  due  to  the  child  having 
irritated  one  of  the  vesicles  by  scratching. 

The  commencement  of  the  eruptive  stage  of  this  disease  is  often 
characterized  by  considerable  itching,  which,  however,  seldom  contin¬ 
ues  for  more  than  one  or  two  days,  and  after  this  has  passed  off  there 
is  very  seldom  any  further  complaint  of  discomfort  of  any  kind. 

Sometimes,  especially  in  girls  of  from  thirteen  to  sixteen  years  of 


TREATMENT  OF  CHICKEN-POX. 


r  r  r 

age,  the  disease  takes  a  more  severe  form,  with  considerable  fever  both 
in  the  stages  of  invasion  and  eruption,  accompanied  by  headache  and 
distaste  for  food.  Even  in  these  cases,  however,  there  is  never  any 
cause  for  real  anxiety.  A  very  exceptional  form  also  occurs  in  which 
the  vesicles,  instead  of  drying  into  scabs,  become  changed  into  un¬ 
healthy  ulcers  ;  its  peculiar  character  is  probably  due  to  residence  in 
very  unsanitary  conditions,  and  it  is  met  with  very  rarely  indeed. 

Chicken-pox,  under  ordinary  circumstances,  involves  no  risk  what¬ 
ever  to  the  life  or  to  the  general  health  of  the  child.  There  is  no  special 
liability  to  any  complications,  nor  is  the  iuvalid  more  than  usually 
susceptible  to  cold  when  suffering  from  it.  The  stage  at  wdiich  infec¬ 
tion  is  most  likely  to  be  given  to  others  is  the  desquamative  stage, 
when  the  scabs  are  becoming  detached,  and  may  be  carried  away  on 
articles  of  clothing,  or  in  other  ways. 

The  Diagnosis  of  Chicken=pox  is  not  usually  difficult.  The  ap¬ 
pearance  of  the  vesicles  when  well  developed  is  very  characteristic,  the 
white  opalescent  color,  the  globular  or  ovoid  shape,  the  pink  areola  or 
circle  round  the  vesicles,  and  the  limitation  of  size  to  a  diameter  not 
much  exceeding  a  quarter  of  an  inch,  not  occurring  in  any  other 
disease.  When  the  vesicles  are  small  and  ill  developed,  there  is  a  risk 
of  mistaking  them  for  heat-spots,  but  their  dispersion  over  the  whole 
body  and  on  the  face  and  head,  together  with  the  absence  of  any  dis¬ 
tinct  hardness,  is  usually  quite  sufficient  to  indicate  their  character. 
When  very  mild,  with  few  and  ill-developed  vesicles,  the  disease  is 
somewhat  apt  to  be  overlooked  altogether,  the  spots  being  mistaken  for 
small  pimples  of  an  innocuous  character.  The  presence  of  chicken- 
pox  in  such  cases  may  be  considered  very  probable,  if  a  crop  of  small 
pimples  with  slight  watery  heads  appear  simultaneously  over  the  body 
and  on  the  face.  Usually  a  careful  examination  in  such  mild  cases 
will  show  on  one  or  two  of  the  spots  vesicles  of  sufficient  development 
to  indicate  with  certainty  the  nature  of  the  illness. 

No  active  treatment  is  required.  If  feverishness  or  sickness  is 
present,  the  patient  should  be  kept  in  bed  for  one  or  two  days,  and 
limited  to  light  food  such  as  milk,  milk  puddings,  and  soups  ;  and  the 
action  of  the  bowels  should  be  regulated.  Itching  is  best  allayed  by 
warm  baths,  and  by  inunction  of  vaseline. 

Caution. — In  order  to  prevent  the  spread  of  infection,  the  invalid 
should  be  isolated  until  every  scab  lias  dropped  off  ;  and  during  the 
desquamative  stage  a  warm  bath,  should  be  given  night  and  morning.  It 
is  not  necessary  to  fumigate  rooms  in  which  a  patient  with  chicken-pox 
lias  been  confined,  but  the  carpet  of  the  room  should  be  beaten  in  the 
open  air,  the  floor  washed  with  carbolic  acid  and  water,  of  a  strength 
of  one  part  of  carbolic  acid  to  forty  of  water,  and  the  room  exposed  to 
a  full  current  of  fresh  air  for  a  whole  day. 


252 


COMMON  MALADIES  OF  CHILDREN. 


(b)  SmaINpox  {variola).  Anything  more  than  a  reference  to  this 
disease  would  be  out  of  place  in  this  work,  as,  even  when  the  attack  is 
very  slight,  the  stage  of  invasion,  which  occurs  after  an  incubative 
period  of  twelve  days,  is  nearly  always  characterized  by  symptoms  of 
such  acuteness  as  to  necessitate  medical  attendance.  Those  take  the 
form  of  severe  headache,  moderately  high  temperature,  often  reaching 
to  104°  F.,  considerable  sickness,  and  markedly  defined  pain  in  the 
back.  If  small-pox  is  prevalent,  the  presence  of  these  four  symptoms 
is  almost  certain  evidence  of  the  commencement  of  an  attack.  The 
stage  of  invasion  usually  lasts  three  days,  after  which  the  eruption 
appears  in  the  form  of  small  red  pimples  rather  hard  and  “sliotty  ”  to 
the  touch,  disseminated  over  the  face  and  body  in  varying  numbers. 
These  pimples  may  in  a  day  or  two  develop  into  small  vesicles,  or  they 
may  gradually  fade,  and  recovery  at  once  ensue.  The  peculiar  feature 
of  modified  small-pox  is  that,  instead  of  going  through  the  usual 
course  of  unmodified  small-pox,  it  is  usually  cut  short  soon  after  the 
appearance  of  the  eruption,  recovery  following  immediately,  and  the 
desquamative  stage  being  so  little  marked  as  almost  to  escape  notice. 
In  unmodified  small-pox  the  pimples  gradually  change  into  vesicles, 
which,  at  first  very  small,  increase  up  to  the  eighth  day  after  the  ap¬ 
pearance  of  the  eruption,  until  they  attain  the  size  of  a  sixpenny  piece 
or  a  silver  dime.  On  the  eighth  day  the  vesicles  become  inflamed,  and 
suppurate,  their  contents  changing  into  matter  ;  they  then  commence 
to  dry  up  or  to  burst,  and  form  hard  scabs,  which  usually  fall  off  in 
the  course  of  ten  days  or  a  fortnight,  leaving  depressed  marks  on  the 
skin.  In  the  modified  form  the  disease  seldom  goes  beyond  the  point 
of  the  formation  of  small  vesicles,  which  dry  quickly  and  fall  off, 
leaving  usually  no  mark  behind. 

( c )  Scarlet  Fever,  or  Scarlatina,  is  a  disease  which  varies  very 
much  in  its  severity  in  individual  cases,  and  in  different  epidemics. 
Sometimes  it  is  so  severe,  and  its  course  so  rapid,  that  it  may  cause 
death  in  twenty-four  hours  ;  at  other  times  so  slight  as  to  involve  to  the 
sufferer  only  a  few  days’  discomfort.  Even  in  the  slightest  instances, 
however,  there  is  always  some  risk  of  serious  complications,  and  it  is 
therefore  desirable  that  all  cases  of  scarlet  fever  should  be  placed 
under  medical  care  and  supervision. 

The  stage  of  incubation  of  scarlet  fever  is  usually  short,  varying 
from  twenty-four  hours  to  six  days.  At  the  end  of  this  stage  the  child 
is  attacked  with  headache,  sickness,  sore  throat,  sometimes  some  shiver¬ 
ing,  and  occasionally,  in  young  children,  convulsive  fits  ;  and  usually 
considerable  fever  is  present,  the  temperature  not  unfrequently  rising 
to  104*  F.  The  stage  of  invasion  lasts  for  about  two  days,  after  which 
the  eruption  appears.  In  mild  cases  the  stage  of  invasion  may  be 
shortened  to  one  day  ;  in  very  severe  cases  it  may  be  prolonged  to  three 


SCARLET  FEVER. 


253 


or  even  four  days.  The  eruption  presents  itself  usually  as  a  general 
flushing  and  reddening  of  the  skin  of  the  face  and  body,  which  on 
close  inspection  is  seen  to  be  caused  by  innumerable  small  scarlet  spots, 
each  surrounded  with  a  small  circle  of  paler  red.  The  spots,  which 
are  about  the  size  of  a  small  pin’s  head,  are  generally  so  closely  aggre¬ 
gated  that  the  paler  circles  round  them  merge  entirely  in  each  other, 
and  thus  produce  the  general  flushing  of  the  skin.  The  eruption  is 
usually  at  first  most  apparent  on  the  neck,  behind  the  ears,  on  the 
chest  and  abdomen,  and  on  the  front  of  the  arms  near  the  elbows. 
Generally  in  the  course  of  twenty-four  hours  it  has  spread  over  the 
whole  body  ;  but  in  some  cases  the  eruption  is  partial  throughout  the 
disease,  limiting  itself  perhaps  to  the  body  and  thighs  and  arms  ;  such 
instances,  however,  are  quite  exceptional.  The  sore  throat,  which  is 
nearly  alw'ays  present  to  some  degree  during  the  stage  of  invasion, 
usually  increases  in  severity  in  the  eruptive  stage  ;  sometimes  a  spotted 
appearance  is  noticed  on  the  roof  of  the  mouth,  as  if  it  also  were 
affected  with  the  eruption. 

The  rash  usually  remains  of  a  vivid  scarlet  hue  for  three  or  four 
days,  after  which  it  fades  into  a  more  dusky  shade,  and  gradually  dis¬ 
appears.  The  stage  of  desquamation  follows,  sometimes  immediately, 
sometimes  after  the  lapse  of  two  or  three  weeks,  and  continues  usually 
until  at  least  six  weeks  have  elapsed  from  the  commencement  of  the 
illness.  The  more  acute  the  eruption  has  been,  the  more  early,  as  a 
rule,  desquamation  commences,  and  the  more  marked  in  character  it 
is.  Sometimes  the  external  skin  comes  off  in  large  flakes  and  shreds  ; 
in  the  case  of  the  fingers  it  may  come  off  in  moulds  like  the  fingers  of 
a  glove.  More  commonly  it  is  shed  in  small  scales,  with  a  few  larger 
shreds  here  and  there.  Desquamation  continues  longest  in  the  hands 
and  feet ;  not  unfrequently  the  process  in  the  feet  is  not  completed 
until  the  expiration  of  nine  or  ten  weeks  from  the  beginning  of  the 
fever.  Occasionally  a  slight  second  desquamation  takes  place  over  the 
body  after  the  first  is  finished. 

The  Diagnosis  of  Scarlet  Fever,  when  the  symptoms  are  well 
marked,  is  very  easy  ;  when  they  are  not  well  marked  it  may  be  ex¬ 
ceedingly  difficult.  In  ordinary  cases  the  nature  of  the  disease  is  in¬ 
dicated  clearly  by  the  somewhat  severe  premonitory  symptoms,  the 
inflamed  throat,  the  degree  of  fever,  and  the  characteristic  scarlet 
color  and  maculated  appearance  of  the  rash.  Slight  cases,  where 
there  is  scarcely  any  soreness  of  throat,  very  -little  fever,  and  a  some¬ 
what  undefined  rash,  are  apt  to  be  mistaken  for  rose-rash.  The  exist¬ 
ence  of  any  soreness  of  throat  should  always  be  regarded  as  suspicious. 
When  there  is  any  fever  with  rose-rash,  it  is  generally  of  short  dura¬ 
tion,  subsiding  within  twelve  or  twenty-four  hours ;  in  scarlet  fever 
the  fever  tends  to  increase  for  the  first  few  days  ;  frequent  observation 


254 


COMMON  MALADIES  OF  CHILDREN. 


with  the  clinical  thermometer  is  therefore  of  value  in  making  the  dis¬ 
tinction.  The  rashes  are  sometimes  very  similar.  The  chief  points  of 
difference  are  the  more  scarlet  hue  of  scarlet  fever,  its  presence 
generally  rather  marked  in  the  face,  which  is  unusual  in  roseola,  and 
its  more  general  distribution  over  the  whole  body  and  limbs,  roseola 
being  usually  present  on  a  more  limited  area.  A  very  characteristic 
feature  of  scarlet  fever,  when  present,  is  a  dry  injected  appearance  of 
the  white  part  of  the  eyes.  The  other  diseases  for  which  scarlet  fever 
may  be  mistaken  are  measles  and  rotlielu  ;  the  points  of  difference  will 
be  mentioned  when  these  diseases  are  described. 

Scarlet  fever  is  an  exceedingly  infectious  disease  in  all  its  stages,  most 
so  during  the  stage  of  desquamation.  The  utmost  care  in  isolation 
and  disinfection  must  be  exercised  to  prevent  its  extension,  and  every 
possible  channel  of  communication  should  be  guarded.  The  necessary 
precautions  have  already  been  mentioned  in  the  chapter  on  Nursing. 
Within  recent  years  many  well-managed  hospitals  for  infectious  dis¬ 
eases  have  been  erected  in  various  towns  in  England  ;  and  where  house¬ 
hold  arrangements  do  not  conveniently  admit  of  rigid  isolation  of  the 
patient,  the  propriety  of  sending  him  to  one  of  those  institutions  should 
be  taken  into  consideration.  Parents  are  not  unnaturally  inclined  to 
think  such  a  course  unkind  to  the  child,  but  it  is  often  dictated  by  the 
best  interests  both  of  themselves  and  of  their  other  children,  while  the 
invalid  is  usually  after  a  day  or  two  more  happy  than  he  would  be  at 
home.  At  home  he  must  be  imprisoned  with  one  person — often  a 
nurse  previously  unknowm  to  him — for  at  least  six  weeks,  without  the 
visit  of  any  friends  or  playfellows  ;  in  the  hospital  there  are  other 
children  suffering  from  the  same  disease,  who  can  spend  with  him  the 
tedious  days  of  convalescence  and  desquamation  in  amusements  and 
games.  And  as  the  hospitals  are  usually  built  specially  for  such  dis¬ 
eases,  the  conditions  are  all  such  as  to  place  the  invalid  in  the  cir¬ 
cumstances  most  favorable  for  complete  recovery. 

(d)  Measles  is  the  most  common  of  all  infectious  eruptive  dis¬ 
eases,  a  distinction  which  it  owes  probably  to  its  very  infectious  charac¬ 
ter  during  the  stage  of  incubation.  The  other  eruptive  fevers  are  only 
very  slightly  infectious  during  their  incubation  ;  measles,  on  the  other 
hand,  in  most  cases  is  transmitted  at  this  stage,  before  any  symptoms 
are  present  rendering  it  possible  to  recognize  in  the  transmitter  the  ex¬ 
istence  of  any  illness  whatever.  The  incubation  stage  of  measles  gen¬ 
erally  lasts  about  twelve  days,  sometimes  a  little  less.  During  the  last 
two  or  three  days  of  this  period  there  may  be  present  a  little  nasal 
catarrh,  with  slight  weakness  of  the  eyes,  and  general  signs  of  slight 
cold  ;  but  this  is  not  invariably  the  case.  The  stage  of  invasion  is 
characterized  by  feverishness,  not  generally  at  all  severe,  slight  head 
ache,  cold  in  the  head,  watering  of  the  eyes,  intolerance  of  light,  and 


MEASLES. 


255 


some  nausea  and  loss  of  appetite.  There  is  also  frequently  some  dry 
ness  of  the  throat,  rarely  amounting  to  actual  soreness,  a  little  hoarse¬ 
ness  of  the  voice,  and  a  slight  dry  cough.  Very  often  those  symptoms 
of  invasion  are  so  slight  as  not  to  necessitate  confinement  to  bed  ; 
sometimes  indeed  they  are  almost  entirely  absent,  so  that  the  patient 
is  going  out  of  doors  until  the  eruption  appears.  The  duration  of  the 
stage  of  invasion  is  generally  about  four  days.  The  eruption  usually 
appears  first  on  the  face  and  the  neck,  in  the  form  of  dusky  crimson 
spots  very  slightly  elevated,  like  pimples,  each  surrounded  by  a  little 
circle  of  paler  red  skin.  As  the  spots  increase  in  number,  and  become 
closely  aggregated,  the  paler  circles  coalesce,  and  the  whole  skin  be¬ 
comes  somewhat  swollen  and  flushed,  and  covered  with  small  prominent 
darker-colored  spots.  Commencing  on  the  forehead  and  neck,  the  erup¬ 
tion  usually  spreads  in  the  course  of  about  twenty-four  hours  down¬ 
ward  over  the  whole  of  the  body  and  limbs.  The  spots  frequently 
tend  to  group  themselves  in  a  crescentic  form,  and  when  the  eruption 
is  not  close  enough  to  obliterate  all  the  healthy  colored  skin  between 
the  spots,  a  series  of  small  red  crescents,  varying  in  size  from  a  quarter 
of  an  inch  to  an  inch  in  diameter,  may  present  themselves  on  the  skin, 
each  made  up  of  a  group  of  spots  with  their  accompanying  pink 
borders.  As  the  eruption  is  coming  out  the  fever  usually  increases 
considerably,  the  temperature  rising  to  104°  F.  or  105°  F.,  but  it 
generally  subsides  immediately  the  rash  is  fully  developed.  Coinci- 
dently  with  the  development  of  the  eruption  the  catarrhal  symptoms 
increase,  the  cold  in  the  head,  the  discharge  from  eyes  and  nose,  and 
the  cough  being  often  very  troublesome.  There  is  often  also  consider¬ 
able  itching  of  the  skin. 

Within  one  or  two  daj's  after  the  appearance  of  the  rash,  it  begins 
to  fade  somewhat  in  brightness,  the  change  being  first  noticed  in  the 
forehead  and  neck,  where  the  eruption  first  appeared,  and  gradually 
extending  to  the  rest  of  the  body.  The  prominence  of  the  papules  at 
the  same  time  diminishes,  and  in  three  or  four  days  all  traces  of  erup¬ 
tion  are  gone,  with  the  exception  of  a  somewhat  mottled  appearance 
of  the  skin  in  some  parts  of  the  body.  As  the  rash  subsides  desquama¬ 
tion  occurs  usually  in  a  very  slight  and  inconspicuous  manner,  the  skin 
coming  off  in  minute  silvery  scales.  Not  unfrequently  the  desquama¬ 
tion  is  so  slight  as  to  be  almost  imperceptible.  It  is  generally  com¬ 
pleted  within  a  week  of  the  disappearance  of  the  eruption. 

The  Recognition  of  Measles  is  very  easy  when  the  symptoms 
are  well  marked.  The  catarrhal  condition  of  the  eyes  and  nose,  the 
troublesome  cough,  the  feverishness,  and  the  crimson  papular  eruption, 
are  quite  sufficient  to  indicate  distinctly  the  nature  of  the  illness. 
When  the  attack  is  mild  and  ill  defined,  it  may  be  mistaken  for  mild 
scarlet  fever  on  the  one  hand,  or  for  rbtheln  or  roseola  on  the  other. 


COMMON  MALADIES  OF  CHILDREN. 


256 

From  scarlet  fever  it  is  distinguished  by  the  more  papular  character  of 
its  eruption,  by  the  crimson  color  as  contrasted  with  the  scarlet  of 
scarlet  fever,  and  by  the  presence  of  some  amount  of  coughing,  a  feat¬ 
ure  rare  in  scarlet  fever.  The  appearance  of  the  eyes  in  measles  also 
differs  much  from  their  aspect  in  scarlet  fever.  In  measles  the  eyelids 
are  swollen,  and  the  eyes  flushed  and  watery ;  in  scarlet  fever  the  eye¬ 
lids  are  not  swollen,  and  the  eyes  are  dry  and  injected.  From  roseola 
measles  is  distinguished  by  its  comparatively  greater  severity,  and  by 
the  presence  of  catarrhal  symptoms  and  cough.  Roseola  is  a  very 
mild  disease,  with  little  or  no  fever  after  the  first  day,  and  no  catarrhal 
symptoms,  except  rarely  very  slightly  inflamed  throat  ;  in  measles 
there  is  nearly  always  some  fever  present  as  the  eruption  develops,  as 
well  as  some  catarrhal  symptoms  in  the  nose,  and  some  amount  of 
coughing.  The  eruption  also  in  measles  is  usually  more  marked,  and 
more  universally  distributed  over  the  body,  than  in  roseola. 

From  rotheln  it  is  often  exceedingly  difficult  to  distinguish  meas¬ 
les.  Points  of  difference  will  be  mentioned  when  the  former  disease 
is  described. 

Treatment  of  Measles. — Mild  attacks  of  measles  call  for  very 
little  treatment.  The  patient  must  be  kept  in  bed  for  some  days,  and 
the  room  must  be  maintained  at  a  uniform  and  moderately  high  tem¬ 
perature.  The  great  risk  in  measles  lies  in  complications  affecting  the 
lungs.  Bronchitis  and  inflammation  of  the  lungs  are  the  most  frequent 
serious  complications  of  measles,  and  they  are  best  guarded  against  by 
the  temperature  in  the  sick-room  never  being  allowed  to  fall  below  64°  F. . 
and  raised  when  necessary  to  70°  F.  When  cough  is  troublesome,  a  steam- 
kettle  should  be  kept  constantly  on  the  fire  ;  if  there  is  indication  of 
difficulty  in  breathing,  the  chest  should  be  enclosed  in  linseed-meal 
poultices.  When  the  cough  is  very  frequent  and  hard,  much  relief  is 
often  afforded  by  the  administration  of  five  or  ten  drops  of  ipecacuanha 
wine  in  a  teaspoonful  of  glycerine  every  three  hours.  When  thirst  is 
troublesome  the  patient  should  be  allowed  to  drink  freely  barley- 
water  flavored  with  lemon  juice  ;  cold  water,  in  small  quantities  at  a 
time,  is  also  very  grateful  and  innocuous.  When  the  skin  is  hot  and 
irritable  much  comfort  is  afforded  by  frequent  sponging  with  tepid 
water,  or  vinegar  and  water. 

Any  indication  of  complications  affecting  the  lungs,  such  as  in¬ 
creased  rapidity  of  breathing,  much  wheezing  in  the  chest,  or  rise  of 
temperature,  after  the  full  development  of  the  eruption,  should  always 
be  considered  as  necessitating  resort  to  skilled  medical  assistance. 

(e)  Rotheln,  or  Epidemic  Roseola,  as  it  is  sometimes  called,  is  an 
infectious  disease  which  occurs  occasionally  in  epidemics,  and  which  in 
some  features  resembles  slight  measles,  in  some  mild  scarlet  fever. 
Its  stage  of  incubation  varies  from  six  to  twenty-one  days,  and  is 


ROTHELN:  MUMPS. 


257 


usually  followed  almost  immediately  by  the  stage  of  eruption,  the 
intermediate  stage  of  invasion  seldom  lasting  more  than  a  day,  and 
often  being  absent  altogether.  The  eruption  usually  resembles  that  of 
measles,  but  the  spots  are  not  generally  so  closely  grouped,  remaining 
discrete,  with  small  distinct  areas  of  pink  skin  round  each  spot.  There 
are  at  first  no  distinct  catarrhal  symptoms  of  eyes  and  nose  as  in 
measles ;  but  the  throat  is  generally  rather  sore,  red,  and  dry,  as  in 
mild  scarlet  fever.  As  a  rule,  there  is  no  cough.  A  very  characteris¬ 
tic  feature,  which  is  nearly  always  present  in  some  degree,  is  enlarge¬ 
ment  and  tenderness  of  the  glands  under  the  skin  at  each  side  of 
the  neck. 

Sometimes  the  eruption  resembles  closely  that  of  mild  scarlet  fever, 
and  when  this  is  combined  with  some  degree  of  inflamed  throat,  it  is 
almost  impossible  at  once  to  make  a  definite  diagnosis.  The  main 
points  of  distinction  are  that  the  eruption  of  rbtheln  usually  fades 
within  two  days,  while  that  of  scarlet  fever  as  a  rule  lasts  three  or  four 
days  ;  that  tenderness  of  the  glands  of  the  neck  is  unusual  in  the 
beginning  of  scarlet  fever,  while  very  common  in  rbtheln ;  and  that 
scarlet  fever  concludes  with  distinct  desquamation,  whereas  in  rbtheln 
no  perceptible  desquamation  occurs.  In  rare  cases  all  points  of  dis¬ 
tinction  fail,  and  the  disease  must  be  treated  with  the  care  due  to 
scarlet  fever,  although  the  probability  may  be  in  favor  of  the  milder 
disease  of  rotheln. 

Treatment  of  Rotheln. — When  the  diagnosis  of  rbtheln  is  cer¬ 
tain,  the  treatment  is  very  simple.  There  is  practically  no  risk  of  any 
dangerous  complication,  and  the  disease  is  always  mild.  Two  or  three 
days’  rest  in  bed,  with  light  diet,  is  generally  all  that  is  necessary  ; 
and  frequently  recovery  is  so  rapid  that  the  patient  is  able  in  a  week 
from  the  commencement  of  the  illness  to  go  out  of  doors,  and  resume 
ordinary  habits  of  life. 

Two  infectious  diseases  are  common  in  children,  which  are  not 
characterized  by  any  eruption  of  the  skin,  but  which  in  some  other 
respects  bear  a  considerable  resemblance  to  the  infectious  eruptive 
fevers  just  described.  These  are  Mumps  and  Whooping-cough. 

Mumps,  or  Parotitis ,  is  a  febrile  infectious  disease  characterized 
by  swelling  and  tenderness  of  some  glands  situated  at  the  side  of  and 
underneath  the  lower  jaw,  and  known  as  salivary  glands,  on  account 
of  their  function  of  secreting  saliva.  Its  stages  of  incubation  varies 
from  eight  to  twenty-one  days,  during  the  latter  part  of  which  there  is 
sometimes  experienced  a  feeling  of  lassitude  and  malaise,  without  any 
definite  symptoms  of  illness.  The  stage  of  invasion  commences  with 
sensations  of  chill,  accompanied  with  rise  of  temperature,  headache, 
and  occasionally  nausea  and  vomiting  ;  and  after  a  few  hours,  or  per¬ 
haps  a  day,  local  symptoms  present  themselves  in  the  form  of  slight 


COMMON  MALADIES  OF  CHILDREN. 


258- 

swelling  and  tenderness  at  the  side  of  the  face  in  front  of  and  below 
the  ear,  or  underneath  the  lower  jaw,  with  stiffness  and  pain  in  moving 
the  jaw  for  the  purpose  of  eating  or  speaking.  Sometimes  the  swell¬ 
ing  at  first  is  present  only  at  the  side  of  the  face,  sometimes  only  under 
the  jaw,  sometimes  in  both  situations  at  once  ;  occasionally  it  affects  at 
first  only  one  side  of  the  head,  in  other  cases  both  simultaneously. 
When  it  appears  at  first  at  the  side  of  the  face,  it  usually  in  a  few  days 
afterward  affects' the  region  under  the  jaw  on  the  same  side  ;  conversely, 
when  it  attacks  the  glands  under  the  jaw  first,  it  generally  invades  that 
on  the  same  side  of  the  face  afterward.  When  it  attacks  at  the  com¬ 
mencement  only  one  side  of  the  face,  it  usually  proceeds  to  the  other 
side  in  a  few  days  ;  when  both  sides  of  the  face  are  affected  at  the  same 
time,  they  often  differ  considerably  in  the  extent  of  the  swelling.  For 
the  first  day  or  two  the  swelling  is  usually  inconsiderable,  but  it  gener¬ 
ally  increases  gradually  for  four  or  five  days,  until  the  side  of  the  face 
presents  a  large  and  tense  swelling,  occupying  the  greater  part  of  the 
cheek  from  the  eye  above,  to  the  bordeiv  of  the  lower  jaw  below,  and 
bounded  behind  by  the  ear,  the  front  part  of  which  is  pushed  outward 
by  the  swelling.  Underneath  the  lower  jaw  the  chin  is  seen  to  be  very 
full  and  swollen,  as  if  the  upper  part  of  the  neck  had  suddenly  become 
very  fat.  The  skin  over  the  swollen  gland  is  seldom  at  all  discolored, 
but  becomes  tense  and  glistening  from  being  stretched.  Not  unfre- 
quently  there  is  some  deafness  and  pain  in  the  ears,  due  to  the  pressure 
of  the  swollen  glands. 

After  remaining  swollen  and  tense  for  a  few  days,  the  glands  be¬ 
come  softer  and  commence  to  subside,  those  which  were  first  attacked 
subsiding  first.  As  the  glands  diminish  in  size,  the  skin  covering  them 
loses  its  tenseness,  becomes  somewhat  dry  in  appearance,  and  usually 
desquamates  in  small  scales. 

Mumps  is  a  very  infectious  disease,  and  may  affect  persons  of  all 
ages  who  are  not  protected  by  a  previous  attack.  It  is  not  a  malady 
of  much  gravity,  but  gives  rise  to  a  great  deal  of  discomfort,  which 
usually  bears  some  proportion  to  the  age  of  the  patient.  Babies  and 
young  children  generally  take  it  very  mildly,  older  children  in  a 
more  marked  form,  while  adults  often  suffer  very  severely.  Like 
measles,  it  is  markedly  infectious  during  the  stage  of  incubation,  as 
well  as  throughout  its  whole  course. 

Treatment  of  Mumps. — Active  treatment  is  not  as  a  rule  called 
for.  The  patient  should  be  kept  warm,  but  not  necessarily  in  bed,  and 
the  diet  should  be  moderately  light  and  nutritious.  Attention  should 
be  paid  to  the  regular  action  of  the  bowels.  To  relieve  the  stiffness 
and  discomfort  arising  from  the  swollen  glands,  gentle  friction  once  or 
twice  daily  with  some  anodyne  liniment,  such  as  opium  liniment  [or 
the  Magnetic  Ointment],  may  be  employed  ;  or,  if  more  grateful  to  the 


WHOOPING-COUGH. 


259 


invalid,  compresses  of  warm  water,  or  linseed-meal  poultices,  maybe  ap¬ 
plied  continuously.  Frequent  sponging  with  warm  water,  followed  by 
the  application  of  cotton-wool,  often  affords  much  comfort.  In  all  cases, 
however  slight,  the  glands  should  be  protected  from  exposure  to  cold 
by  being  constantly  covered  with  a  light  silk  handkerchief  or  small 
woollen  shawl. 

Whooping=cough,  or  Pertussis,  is  an  infectious  fever  of  an  ex¬ 
ceptional  character.  It  is  not  characterized  by  an  eruption,  its  duration 
is  more  indefinite  than  that  of  the  eruptive  fevers,  and  there  is  no  stage 
corresponding  to  the  stage  of  desquamation  in  those  diseases.  Like 
them,  however,  it  has  a  distinct  stage  of  incubation  and  of  invasion, 
and  it  resembles  them  in  being  infectious  throughout  its  whole  course. 

The  stage  of  incubation  of  whooping-cough  occupies  from  a  week 
to  a  fortnight,  during  the  later  days  of  which  a  certain  amount  of 
cough  may  be  present.  The  stage  of  invasion  then  commences  with 
slight  fever,  loss  of  appetite,  and  perhaps  fretfulness,  some  amount  of 
sneezing,  cold  in  the  head  and  eyes,  and  occasionally  a  little  dryness  of 
the  throat.  Cough  is  usually  present  from  the  commencement  of  thL 
stage,  generally  most  noticeable  at  night,  and  most  commonly  barking 
and  croupy,  sometimes  sharp  and  ringing  in  character.  It  is  occasion¬ 
ally  very  incessant  during  the  first  few  nights,  interfering  much  with 
sleep.  At  this  period  no  characteristic  whooping  is  present.  The 
amount  of  fever  is  generally  very  slight,  and  may  only  be  detected  by 
frequent  use  of  the  clinical  thermometer,  which  will  show  a  rise  of 
temperature  to  perhaps  101°  F.  toward  evening.  This  stage  may  last 
for  a  week  to  ten  days,  after  which  the  disease  enters  what  is  known 
as  the  spasmodic  stage,  when  the  catarrhal  symptoms  diminish,  the 
cough  appears  in  more  distinct  spasmodic  fits,  and  the  characteristic 
whoop  begins  to  assert  itself.  Each  fit  of  coughing  consists  of  a  series 
of  short,  quick  coughs,  during  'which  the  face  becomes  swollen  and 
reddened,  followed  immediately  by  a  long  inspiration,  which  soon 
assumes  the  shrill  whistling  or  whooping  sound  from  which  the  disease 
derives  its  name.  It  is  seldom  that  a  distinct  whoop  is  heard  earlier 
than  two  weeks  from  the  commencement  of  the  stage  of  invasion,  and 
sometimes  It  may  not  occur  until  the  end  of  the  third  week.  In  very 
slight  cases  no  distiuct  whoop  may  be  heard  throughout  the  whole 
illness.  In  moderately  severe  cases  three  or  four  or  more  fits  im¬ 
mediately  succeed  each  other,  a  whoop  intervening  between  each  fit ; 
and  the  succession  may  conclude  with  the  expectoration  of  some  whitish 
mucus,  or  even  with  sickness,  and  vomiting  of  the  contents  of  the 
stomach.  Even  when  no  actual  vomiting  occurs,  at  the  end  of  an 
attack  there  is  usually  some  sensation  of  nausea  experienced. 

The  spasmodic  attacks  of  coughing  occur  with  varying  frequency. 

In  mild  cases  there  may  be  only  three  or  four  attacks  during  the  day- 


26o 


COMMON  MALADIES  OF  CHILDREN. 


time,  and  one  or  two  throughout  the  night.  In  more  severe  cases  the 
attacks  may  occur  as  often  as  once  every  hour,  during  both  night  and 
day,  and  in  very  bad  cases  of  whooping-cough  a  much  greater  fre¬ 
quency  even  than  this  may  be  encountered.  The  frequency  and  the 
length  of  the  fits  tend  to  increase  during  the  first  two  or  three  weeks  of 
the  spasmodic  stage,  afterward  usually  diminishing  gradually,  as  con¬ 
valescence  approaches.  The  transition  from  the  spasmodic  stage  to 
the  convalescent  stage  is  gradual.  If  the  disease  has  not  been  compli¬ 
cated  with  any  serious  lung  affection,  such  as  severe  bronchitis  or 
inflammation  of  the  lungs,  usually  after  from  four  to  six  weeks  from 
the  commencement  of  the  stage  of  invasion  the  spasmodic  attacks  will 
become  much  less  frequent,  and  the  cough  will  be  looser  in  character, 
with  fewer  fits  in  each  attack,  and  with  diminished  whoop.  Complete 
recovery,  with  entire  absence  of  cough,  will  then  result  sooner  or  later 
according  to  the  season  of  the  year  and  the  climatic  conditions.  If  the 
affection  has  occurred  in  spring  or  early  summer,  the  convalescent 
stage  may  not  occupy  more  than  one  or  two  weeks,  after  which  no 
cough  will  be  present ;  if,  on  the  other  hand,  the  disease  has  manifested 
itself  in  autumn  or  winter,  convalescence  may  be  prolonged  through¬ 
out  two  or  three  months,  during  which  some  amount  of  cough  remains, 
and  an  occasional  whoop  is  audible. 

The  Diagnosis  of  Whooping-cough  presents  difficulty  only 
when  in  its  early  stages,  or  when  the  disease  is  exceedingly  mild.  Before 
any  whoop  is  developed,  evidence  of  the  nature  of  the  illness  is  afford¬ 
ed  by  the  peculiar  sudden  and  spasmodic  character  of  the  cough,  by 
its  occurrence  once  or  twice  or  oftener  during  the  night,  waking  the 
child  from  sleep,  and  by  the  redness  of  the  face,  and  occasional 
tendency  to  sickness,  immediately  following  the  fit  of  coughing. 
Suspicion  of  whooping-cough  should  always  be  excited  when  two  or 
three  children  associated  together,  who  have  never  had  the  disease, 
begin  to  cough  simultaneously  ;  and  this  suspicion  would  be  much 
strengthened  if  any  of  them  exhibited  a  slight  rise  of  temperature  for 
a  few  days  without  any  apparent  cause  other  than  the  cough.  The 
possibility  of  having  been  exposed  to  infection  should  also  be  taken 
into  consideration  as  rendering  the  diagnosis  more  probable. 

In  very  slight  cases,  where  no  whoop  is  present  from  beginning  to 
end,  the  diagnosis  must  rest  on  the  spasmodic  nature  of  the  cough,  on 
its  occurrence  throughout  the  night,  awaking  the  child  suddenly,  on 
the  redness  of  face  and  tendency  to  sickness  excited  by  the  cough, 
and,  where  two  or  more  children  are  associated  together,  on  ils  in¬ 
fectious  character.  Every  infectious  cough  which  lasts  more  than  a 
few  days  is  whooping-cough. 

Treatment  of  Whooping-cough. — Simple  cases  of  whooping- 
cough  require  very  little  treatment.  Unless  the  weather  is  exceedingly 


TREATMENT  OF  WHOOPING-COUGH. 


261 


mild,  the  invalid  should  for  the  first  three  or  four  weeks  be  confined 
to  one  room,  the  temperature  of  which  should  be  regulated  so  as  to  be 
as  uniform  as  possible,  and  not  to  fall  below  60°  F.  at  any  period  of 
the  day  or  night.  If  much  bronchial  catarrh  is  present,  a  rather  higher 
temperature  may  be  necessary,  and  the  employment  of  a  steam -kettle 
may  be  desirable.  Confinement  to  bed  is  not  necessary  in  uncompli¬ 
cated  cases,  but  the  invalid  should  be  clothed  warmly,  and  should  not 
be  exposed  to  draughts  in  any  way.  The  diet  should  be  light  and 
easy  of  digestion,  any  disorder  of  the  stomach  usually  aggravating  con- 
siderably  the  severity  of  the  cough.  The  chest  should  be  rubbed  well 
once  or  twice  daily  with  some  stimulating  liniment  [the  Magnetic  Oint¬ 
ment  is  just  the  thing  needed].  When  the  cough  is  troublesome  at  night, 
its  frequency  may  be  diminished  by  impregnating  the  atmosphere  of  the 
room  with  carbolic  acid  or  creosote.  This  can  be  effected  either  with 
a  special  vaporizing  arrangement,  such  as  is  sold  by  most  druggists,  or, 
more  simply  and  equally  effectively,  when  a  steam-kettle  is  used,  by 
adding  a  little  carbolic  acid  or  creosote  to  the  water  placed  in  it.  It  is 
found  that  any  disturbance  occurring  during  the  night  is  apt  to  excite 
a  fit  of  coughing  ;  care  should  therefore  be  taken  that  the  invalid  is 
not  subjected  to  any  unnecessary  noises,  or  other  disturbing  influences. 
As  convalescence  approaches,  a  little  more  liberty  may  be  allowed  ; 
on  fine  days  the  patient  may  be  taken  out,  and  when  the  weather  does 
not  admit  of  this,  change  to  another  room  during  the  day  is  advan¬ 
tageous.  [An  infusion  of  dried  red  clover  blossoms  has  been  found 
very  useful  in  whooping-cough.  An  ounce  and  a  half  of  the  blossoms 
in  a  pint  of  boiling  water  is  allowed  to  steep  for  three  hours;  and  a 
wineglassful  of  this  infusion,  sweetened  with  honey  or  sugar,  may  be 
given  every  two  hours.  The  vapor  from  a  few  drops  of  oil  of  turpen¬ 
tine.  dropped  on  a  cloth  near  the  child’s  nose,  makes  a  good  inhaleut.] 

The  complications  most  likely  to  arise  in  whooping-cough  are 
excessive  sickness,  and  inflammatory  affections  of  the  lungs,  including 
bronchitis.  When  bronchitis  supervenes,  the  cough  often  loses  to  some 
extent  its  distinctly  spasmodic  character,  becoming  more  frequent  and 
less  whooping.  At  the  same  time  the  breathing  becomes  quickened, 
and  wheezing  or  gurgling  noises  are  heard  within  the  chest.  If  in¬ 
flammation  of  the  tissue  of  the  lungs  occurs,  the  temperature  rises,  the 
breathing  is  much  quickened,  and  signs  of  irritation  and  fretfulness 
usually  present  themselves.  The  presence  of  either  of  these  complica¬ 
tions  calls  for  skilled  medical  advice. 

Occasional  complications  of  whooping-cough  are  bleeding  from 
the  nose  and  convulsions.  It  is  very  seldom  that  the  bleeding  occurs 
to  an  extent  sufficient  to  do  harm  or  excite  anxiety.  When  excessive, 
the  child  should  be  laid  on  its  back,  with  the  head  elevated,  and  n 
handkerchief  soaked  in  cold  water,  or  better,  a  small  lump  of  ice, 


262 


COMMON  MALADIES  OF  CHILDREN. . 


placed  on  the  forehead,  above  the  nose.  The  elevation  of  the  hands 
and  arms  above  the  head  is  also  of  some  service  in  arresting  bleeding 
from  the  nose. 

Convulsions  should  be  treated  by  placing  the  child  in  a  warm  bath 
of  about  98°  F. ;  and  if  any  disturbance  of  digestion  is  suspected,  an 
emetic  of  ipecacuanha  wine  should  be  given. 

Responsibility  of  Parents  in  Relation  to  Infectious  Diseases. 

— A  considerable  responsibility  rests  on  parents  in  relation  to  the  in¬ 
fectious  diseases  just  described.  There  is  no  doubt  whatever  that  their 
prevalence  could  be  much  abated,  if  due  precautions  were  taken,  when 
single  cases  occur,  to  prevent  the  spread  of  infection,  and  if  convales¬ 
cent  patients  were  always  properly  isolated  until  all  risk  of  infection 
from  them  had  passed  away. 

,In  view  of  the  fact  that  all  are  infectious  to  some  extent  during 
the  stage  of  incubation,  it  is  obviously  proper  that  children  who  have 
incurred  known  risk  of  infection  should  be  isolated  from  others,  until 
the  longest  period  of  incubation  of  the  particular  disease  has  expired. 
Thus  when  a  case  of  measles  occurs  in  a  house,  every  child  resident  in 
it  should  be  withdrawn  from  all  association  with  other  children,  until 
at  least  fifteen  days  have  elapsed  since  there  has  been  any  contact  with 
the  invalid.  If  the  original  case  is  not  isolated  strictly — a  course 
which  is  rarely  taken  with  measles,  on  account  of  the  extreme  prob¬ 
ability  of  infection  having  been  disseminated  before  the  character  of 
the  illness  was  apparent — no  child  in  the  house  should  be  allowed  to 
associate  with  others  until  fifteen  days  after  complete  convalescence  of 
the  latest  patient.  The  same  rule  applies  to  all  the  other  infectious  dis¬ 
eases,  allowance  being  made  for  the  different  duration  of  their  periods 
of  incubation. 

The  prolonged  convalescent  stage  of  whooping-cough,  and  of 
scarlet  fever,  during  the  whole  of  which  infection  may  be  conveyed  to 
others,  calls  for  great  care  and  consideration.  In  whooping-cough  it 
is  practically  impossible  usually  to  confine  the  patient  to  one  room 
until  all  risk  of  infection  disappears,  as  out-door  exercise  and  change 
of  air  may  be  necessary  to  establish  the  cure.  The  one  course  to 
pursue  is  to  avoid  as  much  as  possible  contact  with  other  children,  and 
to  select,  as  a  place  of  change,  some  situation  where  a  reasonable 
amount  of  freedom  of  movement  can  be  obtained  without  risk  of  com¬ 
municating  the  disease.  In  scarlet  fever  it  is  best  to  maintain  the 
isolation  until  all  desquamation  is  completed,  with  the  exception  of  the 
feet ;  if  these  are  then  bathed  thoroughly  with  carbolic  acid  and  water 
of  the  strength  of  1  to  20  night  and  morning,  and  the  stockings  worn 
be  boiled  before  being  sent  to  be  washed,  the  convalescent  patient  may 
mingle  with  others  without  risk.  In  London  some  convalescent  homes 
for  scarlet  fever  patients  exist,  to  which  they  can  be  sent  at  the  very 


PARASITIC  DISEASES,  263 

commencement  of  convalescence  ;  and  it  is  probable  that  similar 
arrangements  will  soon  be  available  in  other  large  towns. 

After  scarlet  fever,  all  the  contents  of  the  room  in  which  the  patient 
has  been  confined  should  be  disinfected  by  some  expert  in  disinfection  ; 
in  most  districts  this  duty  is  now  undertaken  by  the  sanitary  authori¬ 
ties.  Thorough  disinfection  of  the  same  character  is  also  required 
after  small  pox  ;  but  in  the  case  of  measles,  chicken-pox,  rotlieln,  or 
whooping-cough  it  is  generally  considered  sufficient  to  expose  the  room 
thoroughly  to  the  free  ingress  of  fresh  air  for  one  or  two  da}^s,  to  air 
well  the  bedding  and  bed-clothes,  to  take  up  the  carpet,  if  any,  and 
have  it  beaten,  and  to  wash  the  floor  with  a  weak  solution,  about  1  in 
50,  of  carbolic  acid. 

7.  Parasitic  Diseases  are  diseases  resulting  from  the  presence  of 
some  animal  or  vegetable  parasite,  which  derives  its  nourishment  from 
the  person  attacked,  and  grows,  and  frequently  multiplies,  at  his  ex¬ 
pense.  Strictly  speaking,  the  infectious  eruptive  fevers  are  parasitic 
diseases,  as  the  bacteria  which  convey  the  infection,  and  which  are 
present  in  the  blood  as  an  essential  part  of  the  disease,  are  undoubtedly 
of  parasitic  character  ;  but  in  general  the  term  is  restricted  to  diseases 
in  which  the  parasite  is  of  a  more  conspicuous  and  tangible  character. 
The  disease  already  described  under  the  name  of  “  thrush”  is  a  typical 
instance.  A  few  other  common  ones  will  now  be  described. 

(a)  Ringworm  affecting  the  scalp  is  a  common  disease  in  children, 
due  to  the  development  at  the  roots  of  the  hair  of  a  vegetable  parasite, 
named  scientifically  trycophyton  tonsurans.  Its  presence  is  usually 
indicated  first  by  the  appearance  on  the  head  of  one  or  more  spots, 
more  or  less  circular  in  shape,  on  which  the  hair  appears  thinner,  or  is 
absent  altogether,  while  the  skin  has  lost  its  smoothness,  presenting  a 
somewhat  rough  and  pimply  surface.  The  spots  may  vary  in  size  from 
a  threepenny  piece  to  a  shilling  [half-dime  to  a  twenty-five  cent  piece] 
or  larger  ;  and  tend  to  spread  in  every  direction,  losing  to  some  extent 
their  circular  shape,  and  becoming  irregular  in  outline.  As  the  cir¬ 
cumference  of  each  spot  extends,  the  centre  may  become  smoother  and 
more  healthy  looking,  the  parasite  exhausting  the  nutrition  there,  and 
spreading  out  from  the  centre  in  search  of  healthy  hairs.  If  any  spot 
is  examined  carefully,  it  will  be  observed  not  only  that  the  normal  hair 
is  much  thinner,  or  is  absent  altogether,  but  also  that  short  broken  off 
stumps  of  hair  are  to  be  seen  scattered  over  the  spot,  the  remains  of 
normal  linirs  which  have  been  attacked  and  broken  off  by  the  invasion 
of  the  parasite.  These  short  stumps  are  the  most  characteristic  sign 
of  the  disease,  and  when  present  to  any  extent  indicate  with  certainty 
its  nature.  Any  one  in  the  habit  of  using  a  microscope  can  verify  the 
presence  of  the  parasite  by  pulling  out  one  of  the  short  stumps  and 
examining  it  under  a  moderately  strong  power.  It  will  be  seen  not 


COMMON  MALADIES  OF  CHILDREN. 


264 

only  surrounding  the  root,  but  actually  invading  the  hard  tissue  of  the 
hair,  in  the  form  of  innumerable  small  round  spores. 

The  disease  is  of  very  indefinite  duration,  if  not  subjected  to  active 
and  skilled  treatment.  The  spots  may  increase  in  size  until  they 
coalesce,  and  in  time  the  whole  of  the  scalp  may  be  affected,  all  the 
hair  being  lost.  This  may  continue  for  months  or  years,  after  which 
apparently  the  parasite  becomes  exhausted,  healthy  action  of  the  hair- 
follicles  is  set  up,  and  the  hair  again  grows  normally 

Ringworm  of  the  scalp  is  very  infectious,  spreading  from  one 
child  to  another  with  great  facility.  Adults,  however,  are  very  seldom 
indeed  attacked  with  it,  their  hair  apparently  possessing  a  resisting 
power  which  the  parasite  is  unable  to  overcome. 

Successful  treatment  must  be  carried  out  under  skilled  medical 
advice.  Even  with  the  utmost  care,  it  will  occupy  at  least  three 
months  ;  and  often  six  months  will  elapse  before  the  cure  is  complete. 
The  rapidity  of  cure  is  determined  much  more  by  the  thoroughness 
with  which  the  treatment  is  applied,  than  by  the  selection  of  the 
individual  remedy  to  be  used.  Perfunctory  application  of  remedies  is 
practically  useless ;  and  mothers  will  find  generally  that  it  is  best  to 
take  the  entire  management  into  their  own  hands,  instead  of  leaving  it 
to  nurses  or  attendants  ;  feeling  assured  that  perseverance,  energy,  and 
hopefulness  in  the  application  of  prescribed  remedies  will  ultimately 
result  in  success. 

During  the  course  of  the  disease  children  affected  must  be  isolated 
from  others,  but  confinement  to  the  house  is  neither  necessary  nor 
desirable.  The  constant  use  of  a  silk  or  linen  skull-cap  during  both 
day  and  night,  while  the  treatment  is  being  carried  out,  is  of  much 
value  in  preventing  the  dissemination  of  the  fungus  which  gives  rise 
to  the  malady. 

(6)  Itch,  or  Scabies,  is  a  skin  disease  resulting  from  irritation 
caused  by  a  small  animal  parasite  called  an  acarus.  It  is  alway.-t 
acquired  by  direct  infection,  the  little  animal  making  its  way  from  the 
skin  of  one  person  to  that  of  another,  either  by  direct  contact  or  by 
transmission  in  articles  of  clothing.  The  symptom  which  usually 
first  calls  attention  to  its  presence  is  intense  itching,  commonly  worst 
soon  after  the  child  is  put  to  bed.  Careful  examination  of  the  skin  at 
this  time  will  generally  reveal  the  presence  of  some  small  elevated  pim¬ 
ples,  the  heads  of  which  are  often  torn  off  by  the  amount  of  scratching 
induced,  and  replaced  by  small  specks  of  blood.  These  pimples  are 
usually  seen  first  in  the  angles  between  the  fingers,  but  may  occur  on 
any  other  part  of  the  skin.  As  the  disease  progresses  the  skin  shows 
general  signs  of  irritation,  becoming  roughened  and  pimply  at  differetil 
places,  and  scarred  with  traces  of  severe  scratching.  The  face  almost 
invariably  escapes  attack.  The  duration  of  the  affection  is  unlimited, 


THREAD-WORMS. 


265 


continuing  until  proper  means  of  cure  have  been  successfully  applied. 

The  Diagnosis  rests  mainly  on  the  sites  of  the  irritation,  associ¬ 
ated  with  distinct  evidence  of  contagion.  If  two  or  more  children  or 
adults  in  one  household  suffer  for  a  little  time  from  severe  itching, 
becoming  intensified  on  going  to  bed,  and  if  signs  of  irritation  are 
visible  between  the  fingers,  the  probability  is  very  strong  that  they  are 
suffering  from  scabies.  Absolute  certainty  can  only  be  attained  by  the 
discovery  of  one  of  the  acari  causing  the  affection,  the  search  for 
which  calls  for  some  patience  and  medical  skill,  as  it  is  minute  in  size, 
and  usually  concealed  under  the  skin. 

Treatment  of  Itch. — When  the  disease  is  diagnosed  the  cure  is 
easy.  The  little  animal  upon  which  it  depends  is  destroyed  by  the 
thorough  application  of  sulphur  to  the  skin.  For  one  or  two  nights 
successively  the  patient  should  be  given  a  warm  bath,  then  rubbed 
well  all  over  the  skin  of  the  body  with  sulphur  ointment,  the  face  and 
head  being  omitted,  and  put  to  bed  clothed  in  the  under-garments 
worn  during  the  previous  day.  In  the  morning  these  garments  should 
be  removed,  another  warm  bath  given,  and  clean  underclothing  put 
on.  After  this  has  been  done  two  nights  in  succession  the  cure  is 
usually  complete,  but  it  is  generally  safer  for  a  few  nights  afterward 
to  rub  some  sulphur  ointment  into  those  parts  of  the  body  most  severe¬ 
ly  attacked,  so  as  to  ensure  complete  eradication. 

(c)  Thread-worms,  or  Ascarides,  are  small  whitish  thread-like 
worms,  varying  in  length  from  about  a  quarter  to  half  an  inch,  which 
infest  the  low'er  bowel  of  many  children,  and  often  create  considerable 
itching  around  the  external  opening  of  the  bowel.  During  the  day 
they  remain  within  the  bowel,  and  give  rise  to  little  or  no  discomfort, 
but  at  night  they  are  apt  to  make  their  way  outside,  causing  restless¬ 
ness  and  itching.  Occasionally  they  wander  so  far  that  they  may  be 
found  on  the  bed  sheets,  and  it  is  probable  that  sometimes  when  two 
children  are  sleeping  together  they  migrate  from  one  to  the  other. 

Suspicion  of  the  presence  of  thread-worms  in  young  children  is 
usually  aroused  by  some  indications  of  irritation  of  the  digestive  canal. 
Restlessness  at  night,  talking  in  sleep,  occasional  grinding  of  the  teeth, 
twitching  of  the  face,  and  sometimes  convulsions,  call  attention  to  the 
presence  oT  some  source  of  irritation,  and  careful  examination  of  the 
motions  of  the  child  for  a  few  days  will  demonstrate  their  presence,  if 
they  exist  in  any  quantity.  The  thread-worms,  when  present  in  the 
motions,  are  easily  recognised  by  their  whitish  color  and  thread-like 
appearance,  their  length,  which  varies  from  one  fourth  to  three-fourths 
of  an  inch,  and  occasionally  by  their  power  of  movement.  Older 
children  will  complain  of  itching  around  the  opening  of  the  bowel,  a 
situation  which  is  very  little  liable  to  suffer  from  irritation  in  children 

from  any  other  cause  than  the  presence  of  thread-worms. 

9a 


266  COMMON  MALADIES  OF  CHILDREN. 

It  is  somewhat  doubtful  how  the  disease,  which  is  very  common,  is 
usually  acquired.  The  microscopic  eggs  of  the  animals  must  be 
swallowed  attached  to  some  food,  and  it  is  probable  that  raw  fruit  and 
uncleaned  raw  vegetables  are  a  frequent  vehicle  of  infection.  It  is  a 
matter  of  no  doubt  that  the  affection  is  frequently  intensified  by  want 
of  cleanliness  of  the  hands  of  the  patients.  The  thread-worms  set 
up  an  irritation  round  the  opening  of  the  bowel,  which  the  child 
attempts  to  allay  by  scratching  with  the  nails  ;  eggs  of  the  thread¬ 
worm  are  often  adherent  to  the  skin  in  that  situation,  and  become 
lodged  under  the  nails,  from  wdience  they  are  conveyed  to  the  mouth 
of  the  child. 

Thread-worms  should  never  be  considered  as  a  necessary  evil  to  be 
put  up  with  in  children.  They  do  considerable  injury,  not  only  by  the 
irritation  they  give  rise  to,  but  also  by  tlieir  secondary  effects,  and 
should  be  combated  by  skilful  medical  treatment.  Their  transmissi- 
bility  by  unclean  hands  and  nails,  referred  to  above,  should  impress 
upon  mothers  and  nurses  the  absolute  necessity  of  aiding  medical  treat¬ 
ment  by  strict  attention  to  cleanliness. 

8,  Diathetic  or  Constitutional  Diseases  are  diseases  resulting 
from  some  constitutional  taint  or  predisposition,  which  may  be  either 
inherited,  or  developed  by  various  insanitary  conditions  of- life,  and 
which  is  frequently  due  to  a  combination  of  these  causes.  In  children 
the  most  common  of  these  diseases  are  rheumatism,  scrofula,  and 
rickets. 

J  (a)  Rheumatism  as  it  occurs  in  children  is  met  wfitli  in  three 
forms, — acute  rheumatic  fever,  subacute  rheumatism  affecting  one  or 
more  joints,  and  rheumatism  of  the  muscles.  Perhaps  the  most 
common  of  the  three,  and  certainly  the  most  insidious,  as  its  apparent 
slightness  not  unfrequently  induces  neglect,  with  serious  ulterior  con¬ 
sequences,  is  subacute  rheumatism  in  a  mild  form,  affecting  at  most 
two  or  three  joints.  Both  this  form  and  acute  rheumatic  fever  are 
prone  to  be  complicated  with  inflammatory  affections  of  the  valves  of 
the  heart,  resulting  in  time  in  chronic  heart  disease  ;  and  this  complica¬ 
tion  occurs  almost  as  frequently  in  slight  attacks  as  in  severe  ones.  It  is 
unnecessary  to  describe  acute  rheumatic  fever,  as  it  is  an  illness  of  such 
severity  as  invariably  to  demand  medical  attendance :  the  description 
given  here  will  be  limited  to  mild  attacks  of  subacute  rheumatism  of 
the  joints,  with  a  few  remarks  on  muscular  rheumatism. 

The  first  and  most  striking  symptom  of  rheumatism  is  pain  in  some 
particular  joint  or  joints,  increased  by  movement  of  the  joint,  and 
accompanied  usually  by  some  tenderness  on  pressure.  When  a  child 
,is  not  old  enough  to  complain  verbally,  it  will  be  noticed  that  there 
is  reluctance  to  move  one  or  other  of  the  limbs,  a  tendency  to  hold  the 
limb  in  a  stiff  position,  and  a  disposition  to  cry  upon  movement.  If 


RHEUMATISM. 


267 


the  various  joints  be  pressed  by  the  hand,  or  moved  gently,  the  child 
will  show  symptoms  of  discomfort  and  pain.  Generally  associated 
with  pain,  almost  from  the  commencement  of  the  illness,  is  some  degree 
of  swelling  of  the  joint  affected.  The  swelling  is  frequently  not  well 
marked,  but  is  usually  easily  detected  if  comparison  be  made  with  the 
similar  joint  on  the  opposite  side  of  the  body.  Sometimes  it  is  con¬ 
siderable,  and  causes  tension  of  the  skin  with  a  puffy  semitranslucent 
aspect.  It  is,  seldom  that  the  skin  is  at  all  discolored.  Some  slight 
amount  of  fever  may  or  may  not  be  present  ;  there  is  usually  observ¬ 
able  some  impairment  of  digestion,  and  slight  lassitude  and  disinclina¬ 
tion  for  play.  The  pain  and  swelling  may  continue  for  a  few  days, 
and  then  disappear  altogether,  leaving  the  child  apparently  well  ;  or 
they  may  appear  in  another  joint,  somewhat  prolonging  the  illness. 

Subacute  rheumatism  is  seldom  a  disease  of  much  severity  or  long 
duration,  and  its  importance  arises  mainly  from  the  possibility  of  its 
being  complicated  with  some  inflammation  of  the  valves  of  the  heart, 
which  gives  rise  to  no  immediate  symptoms,  but  may  make  itself  ap¬ 
parent  either  soon  afterward,  when  the  rheumatism  has  disappeared, 
or  in  later  years  of  life.  This  form  of  heart  affection  may  result  from 
the  very  mildest  attack  of  rheumatism  of  the  joints  ;  occasionally, 
indeed,  it  occurs  when  the  joints  are  apparently  quite  unaffected  ;  a 
slight  degree  of  fever,  and,  perhaps,  some  little  stiffness,  alone  being 
present  to  indicate  the  rheumatic  nature  of  the  illness.  It  is  in  order, 
as  far  as  possible,  to  prevent  the  occurrence  of  heart  complications, 
that  early  recognition  and  early  treatment  of  the  very  mildest  rheuma¬ 
tic  attacks  arc  so  important.  The  recognition  must  be  based  on  the 
coexistence  of  pain  and  slight  swelling,  in  the  absence  of  any  injury 
likely  to  have  caused  them.  It  is  when  only  one  joint  is  affected  that 
the  difficulty  of  diagnosis  mainly  presents  itself.  Children  in  their 
play  are  apt  to  strain  joints  slightly,  and  may  complain  of  pain  or 
stiffness  for  a  few  days  afterward.  The  distinction  lies  chiefly  in  the 
character  of  the  swelling.  When  a  joint  has  been  injured  by  accident 
there  will  not  unfrequently  be  seen  some  discoloration  from  bruising, 
and  when  no  signs  of  bruise  are  present,  the  swelling  is  soft,  and  of  a 
fluid  character  to  touch  ;  when  affected  with  rheumatism  no  bruising 
is  noticeable,  any  slight  discoloration  present  is  of  pinkish  hue,  and  the 
swelling  tends  to  be  rather  puffy  and  doughy  when  handled.  In 
rheumatism  the  tenderness  to  touch,  and  pain  on  movement,  of  the 
joint  are  usually  greater  than  in  inflammation  of  a  joint  from  accident. 
When  two  or  more  joints  are  affected,  there  is  little  room  for  doubt,  as 
it  is  very  rarely  that  more  than  one  joint  is  injured  by  accident  at  one 
lime.  Complaints  of  pain  in  the  limbs  from  children  should  always 
excite  suspicion  of  rheumatism.  Children  are  not  prone  to  make  com¬ 
plaint  of  pain  unless  there  is  reason  for  it,  and  attention  should  always 


268 


COMMON  MALADIES  OF  CHILDREN. 


be  directed  to  discovering,  if  possible,  the  source  of  the  discomfort. 

The  proper  treatment,  when  any  symptoms  of  rheumatism  affect¬ 
ing  the  joints  are  observed,  is  to  confine  the  child  to  bed,  clothed  in 
flannel,  and  placed  between  blankets  without  any  sheets,  to  restrict  it 
to  milk  food,  and  to  place  it  under  medical  supervision  as  early  as 
possible. 

Children  occasionally  suffer  from  rheumatism  affecting  the  muscles. 
In  this  form  there  is  no  tendency  to  complications  affecting  the  heart ; 
and  as  the  pain  is  seldom  acute,  the  malady  is  one  of  very  minor  im¬ 
portance.  Muscular  rheumatism  may  occur  in  any  part  of  the  body  ; 
the  muscles  of  the  back  and  shoulders  are  perhaps  the  most  frequently 
affected.  The  symptoms  are  pain,  usually  increased  by  some  particular 
movements,  some  degree  of  stiffness,  and  occasionally  a  little  tender¬ 
ness  on  pressure.  When  these  three  symptoms  are  found  in  a  child 
otherwise  well,  and  nothing  further  is  noticeable  to  which  they  might 
be  referred,  the  probability  is  that  they  are  the  result  of  muscular 
rheumatism.  The  duration  of  this  form  of  rheumatism  is  short,  seldom 
exceeding  one  or  two  days.  It  is  generally  the  result  of  some  exposure 
to  draught  on  a  limited  part  of  the  body,  and  seldom  calls  for  any 
treatment  beyond  the  maintenance  of  warmth,  and  the  soothing  of  pain 
by  the  application  of  a  mild  mustard  and  linseed-meal  poultice,  or  by 
friction  with  some  anodyne  liniment.  [The  Magnetic  Ointment  is  ser¬ 
viceable  for  this,  and  the  Anti-rheumatic  Tablets,  No.  8.  See  page  1228.] 

(b)  Scrofula  is  a  constitutional  taint  which  manifests  itself  most 
conspicuously  by  a  tendency  to  chronic  enlargement  of  glands,  pro¬ 
ceeding  from  a  low  form  of  inflammatory  action,  and  often  resulting 
in  the  formation  of  matter.  The  glands  specially  affected  by  this 
malady  are  known  as  lymphatic  glands,  and  are  distributed  all  over 
the  body,  being  specially  numerous  in  the  neck,  the  armpit,  the  groin, 
and  one  or  two  other  situations.  Normally  they  are  so  small  and  soft 
as  to  be  undetectable  by  sight  or  touch,  even  when  situated  immediate¬ 
ly  under  the  skin  ;  when  somewhat  enlarged,  they  are  recognizable 
to  touch  as  small  rounded  or  oval  beads,  somewhat  separated  from 
each  other,  and  occurring  usually  in  chains  ;  as  they  increase  further 
in  size,  they  become  apparent  as  prominent  swellings,  varying  in  size 
from  a  pea  or  bean  to  a  billiard-ball,  smooth  in  outline,  more  or  less 
movable  under  the  skin,  and  painless  to  touch  unless  acutely  inflamed. 

Lymphatic  glands  never  become  enlarged  unless  some  source  of 
irritation  exists  on  the  surface  of  the  skin,  or  mucous  membrane,  or  other 
tissue  with  which  they  are  immediately  connected.  In  the  case  of  the 
lymphatic  glands  of  the  neck,  the  source  of  irritation  may  be  found 
in  some  affection  of  the  scalp  or  of  the  hair,  in  some  disease  of  the  ear, 
of  the  throat,  or  of  the  nose,  or  in  some  inflammatory  disturbance  con¬ 
nected  with  the  teeth.  In  those  of  the  armpits  and  groins,  the  initia- 


SCROFULA. 


269 

tory  irritation  is  usually  discernible  in  some  injury  or  inflammatory 
affection  of  the  hands  or  arms,  or  of  the  feet  or  legs.  Even  in  perfectly 
healthy  children,  sources  of  irritation  such  as  have  been  mentioned 
will  occasionally  excite  some  enlargement,  and  a  little  tenderness  of 
the  associated  glands.  The  striking  peculiarity  of  scrofulous  children 
is,  that  in  them  the  lymphatic  glands  become  enlarged  with  very  much 
slighter  provocation  than  in  healthy  children,  and  when  enlarged,  do 
not  subside  and  become  reduced  when  the  source  of  irritation  is  re¬ 
moved,  as  happens  usually  when  no  scrofulous  taint  exists.  Such  per¬ 
sistently  enlarged  glands  are  known  as  scrofulous  glands. 

In  many  instances  the  exciting  cause  of  the  enlargement  is  so  slight 
and  temporary,  that  all  trace  of  it  may  have  disappeared  before  the  en¬ 
largement  of  the  glands  becomes  manifest ;  it  should,  however,  always 
be  searched  for,  as  its  early  discovery  and  treatment  may  modify  very 
much  the  extent  and  degree  of  the  enlargement.  Not  unfrequently 
the  source  will  be  found  in  some  slight  chronic  inflammation  of  the 
skin,  or  some  irritable  condition  of  the  mucous  membrane  lining  the 
nose,  mouth,  or  throat.  Among  the  more  common  of  these  are  eczema 
of  the  scalp  and  behind  the  ear,  inflammation  of  the  external  passage 
of  the  ear,  with  discharge,  chronic  inflammation  of  the  eyelids,  gum¬ 
boils,  and  enlargement  of  the  tonsils.  These  are  all  very  frequently 
found  originating  scrofulous  enlargement  of  the  glands  on  either  side 
of  the  neck. 

Scrofulous  glands,  after  their  initial  enlargement,  often  remain 
constant  in  size  and  absolutely  painless  for  many  months  or  years. 
They  are,  however,  exceedingly  liable,  as  the  result  of  some  fresh 
irritation,  or  of  exposure  to  cold,  or  of  depressed  health,  or  even  of 
direct  injury,  to  take  on  acute  inflammatory  action,  and  develop  into 
abscess.  When  this  occurs,  the  gland  becomes  increased  somewhat 
in  size,  tender  to  touch,  less  movable  under  the  skin,  and  more  doughy  in 
character  ;  some  amount  of  throbbing  and  sense  of  heat  are  usually 
experienced  in  it,  while  the  skin  over  it  becomes  gradually  of  a  dusky 
red  color.  In  a  little  time  matter  forms,  and  if  not  allowed  to  escape 
by  incision  of  the  skin  over  it,  it  breaks  through,  by  making  one  or 
more  small  ragged  openings  for  itself,  and  continues  to  ooze  out 
through  these  openings  for  an  indefinite  time,  fresh  matter  being 
always  formed  by  the  unhealthy  remnants  of  the  gland  underneath 
the  skin. 

When  the  enlarged  gland  is  not  excited  to  further  inflammation  and 
formation  of  matter  by  any  of  the  causes  mentioned,  and  when  the 
general  health  improves,  partial  absorption  may  occur,  the  gland  be¬ 
coming  smaller  and  harder,  and  in  time  sometimes  almost  entirely 
disappearing. 

Scrofulous  children  are  always  more  delicate  than  others,  not  only 


2  70 


COMMON  MALADIES  OF  CHILDREN. 


in  their  tendency  to  enlargement  of  glands,  but  also  in  tlieir  proneness ' 
to  inflammatory  attacks  of  various  kinds.  They  are  especially  liable  ' 
to  bronchitis,  to  enlargement  of  the  tonsils,  to  disturbances  of  the' 
digestive  system,  and  to  some  affections  of  the  skin  and  bones  ;  and  are 
very  susceptible  to  injury  from  exposure  to  cold.  The  disease  also 
tends  to  the  development  of  consumption  in  later  life. 

Scrofula  owes  its  origin  largely  to  hereditary  taint,  but  it  is  also' 
frequently  developed,  and  still  more  frequently  aggravated,  by  residence 
in  insanitary  conditions.  Dampness  of  soil,  inefficient  drainage,  impure 
water-supply,  and  want  of  sunshine  are  fertile  promoters  of  the  disease  ; 
and  improper  diet  also  assists  in  its  development.  It  is  much  more 
common  in  low-lying  inland  towns  than  among  the  uplands  or  at 
the  sea-side. 

Treatment  01  Scrofula. — -The  general  treatment  of  scrofula  re¬ 
solves  itself  into  the  removal  of  all  sources  of  irritation  likely  to  excite 
the  sensitive  lymphatic  glands,  and  the  maintenance  of  the  highest 
attainable  standard  of  health.  All  inflammatory  affections,  such  as 
have  been  mentioned  above  as  originating  enlargement  of  glands, 
should  be  referred  to  medical  care  as  soon  as  they  appear,  and  treat¬ 
ment  should  be  persevered  in  until  complete  cure  results.  At  the  same 
time,  great  care  should  be  directed  to  the  general  health  of  the  child  ; 
warm  clothing,  regular  exercise,  nourishing  diet,  and,  as  far  as  pos¬ 
sible,  an  open-air  life  are  of  essential  importance.  Change  of  air 
occasionally  is  also  of  much  value  ;  children  having  their  home  inland 
should  be  sent  preferably  to  the  sea-coast,  while  those  wdiose  usual 
residence  is  near  the  sea  should  be  transferred  to  elevated  inland 
resorts.  Independently  of  change,  it  is  undoubted  that  residence  in 
bracing  sea-side  places,  such  as  towns  on  the  east  coast  of  England  and 
Scotland,  is  very  beneficial  for  scrofulous  children,  a  fact  which  should 
be  taken  into  consideration  when  any  question  arises  of  sending  chil¬ 
dren  affected  with  this  disease  to  schools  away  from  home. 

Treatment  by  medicine’  occupies  a  very  inferior  position  to  the 
hygienic  measures  described  ;  the  undoubted  value  of  cod-liver  oil 
in  scrofula  is  probably  quite  as  much  due  to  its  quality  as  an  easily 
digested  fatty  food,  as  to  any  specific  medical  virtue  it  may  possess. 
[Botanical  blood -purifying  treatment  can  be  very  effectively  employed 
in  such  cases,  and  should  be  before  incurable  damage  from  scrofulous 
inflammations  has  had  a  chance  to  impair  the  child  for  life.  See 
page  1226.]  The  management  of  glands  inflamed  and  threatening  to 
form  matter  must  be  intrusted  to  a  medical  man.  As  the  glands  are 
often  situated  rather  conspicuously,  it  is  of  much  importance  that  the 
scar  resulting  from  formation  of  matter  should  be  as  small  and  as  little 
visible  as  possible ;  and  much  can  be  done  to  effect  this  by  careful 
treatment,  and  by  surgical  interference  at  the  proper  moment. 


RICKETS. 


271 


(c)  Rickets  is  a  disease  affecting  the  general  health,  and  more 
especially  the  bony  development,  of  children,  which  results  chiefly 
from  improper  diet  and  unhealthy  conditions  of  life,  but  is  also  some¬ 
times  apparently  traceable  to  hereditary  influences.  Its  most  common 
cause  undoubtedly  is  defective  nutrition  from  insufficient  or  indigesti¬ 
ble  food  in  early  life,  and  the  disease  is  accordingly  much  more  com¬ 
mon  in  children  artificially  fed,  than  in  those  nursed  by  their  mothers 
or  by  wet  nurses.  Residence  in  houses  badly  ventilated  or  imperfectly 
drained,  or  deprived  of  a  due  amount  of  sunshine,  also  .conduces  much 
to  the  development  of  rickets  ;  and  consequently  it  is  encountered 
much  more  frequently  in  the  poorer  districts  of  over-crowded  towns, 
than  among  the  peasantry  in  country  villages. 

Rickets  may  commence  at  any  time  during  the  earlier  years  of  life 
Most  commonly  it  makes  its  appearance  during  the  period  of  the  first 
dentition,  between  the  ages  of  six  mouths  and  two  years. 

The  first  symptom  observed  is  usually  a  tendency  to  perspiration 
on  going  to  sleep,  affecting  generally  the  whole  of  the  head,  face,  and 
neck.  This  symptom  is  often  so  striking,  that  within  a  few  minutes 
after  the  child  goes  to  sleep  the  head  will  be  seen  to  be  covered  with 
drops  of  perspiration,  which  continue  during  the  whole  period  of 
sleep.  Coincidently  wfitli  this  there  is  usually  some  restlessness  during 
sleep,  which  causes  the  child  to  throw  off  the  bed-clothes  even  in  cold 
weather,  and  a  tendency  to  roll  the  head  on  the  pillow  in  such  a  way 
as  to  result  sometimes  in  thinning  of  the  hair  on  the  back  of  the  head. 
At  the  same  time  is  often  observable  some  enlargement  of  the  ends  of 
the  bones  of  the  arms  and  legs,  the  wrist-joints,  the  ankle-joints,  and 
the  knees  especially  appearing  larger  than  in  healthy  children.  Some 
enlargement  of  the  head  also  is  usually  present,  and  a  very  noticeable 
feature  is  enlargement  of  the  fontanelles  on  the  top  of  the  head,  and 
arrest  of  their  closure.  In  describing  the  fontanelles  in  Chapter  XI. 
it  was  remarked  that  by  the  end  of  ihe  first  year  of  life  they  have 
usually  diminished  very  much,  and  have  disappeared  altogether  before 
two  years  of  healthy  life  have  expired  ;  in  rickety  children,  on  the 
other  hand,  at  the  end  of  one  year  they  may  be  found  larger  than  at 
birth,  and  may  be  widely  open  even  after  two  years.  Associated  with 
this  arrest  of  closure  of  the  fontanelles,  late  development  of  the  teeth 
is  frequently  observed  ;  children  suffering  from  rickets  may  not  com¬ 
mence  teething  until  more  than  a  year  old,  and  may  not  complete  their 
first  dentition  until  after  three  years  from  birth. 

Accompanying  or  following  closely  on  those  symptoms  comes  the 
particular  feature  which  specially  characterizes  the  disease — the  soften¬ 
ing  affects  to  some  extent  all  the  bones  of  the  body  ;  in  children  able 
to  walk,  those  of  the  leg  are  usually  the  most  distorted,  as  they  suffer 
more  than  others  from  pressure.  In  such  cases  the  legs  are  bent  and 


272 


COMMON  MALADIES  OF  CHILDREN. 


twisted,  assuming  most  usually  a  curve  outward,  but  sometimes  being 
inclined  forward  and  inward.  The  bones  of  the  head  also  alter  in 
shape,  the  skull  becoming  elongated  and  usually  somewhat  flattened 
on  the  top,  while  the  forehead  becomes  square,  prominent,  and  some¬ 
times  almost  overhanging.  At  the  same  time,  the  face  seems  some¬ 
what  smaller  than  normal,  the  development  of  the  bones  entering  into 
its  formation  being  arrested. 

The  bones  forming  the  spine  become  somewhat  softened,  and  as  the 
muscles  supporting  them  are  weakened  by  the  disease,  the  child  is 
observed  to  be  “  wreak  in  the  back,”  does  not  sit  up  like  other  children 
of  its  age,  and  tends  to  lie  down,  or  to  loll  in  its  chair.  Softening  of 
the  bones  of  the  chest  gives  rise  to  hollowness  on  either  side  of  the 
breast-bone,  which  projects  forward,  and  produces  the  appearance 
which  is  known  when  very  marked  as  “pigeon-breast.” 

Rickety  children  are  particularly  susceptible  to  injury  from  ex¬ 
posure  to  cold.  From  the  slightest  chill  they  contract  severe  attacks 
of  bronchitis,  pneumonia,  and  intestinal  catarrh,  and  recover  from 
them  much  more  slowly  and  with  greater  difficulty  than  healthy  chil¬ 
dren.  They  are  also  very  prone  to  disorders  of  the  nervous  system, 
more  especially  to  spasmodic  croup,  and  to  convulsive  fits. 

The  Diagnosis  of  Rickets  is  usually  very  easy,  even  in  its  early 
stage,  before  almost  any  deformity  of  bones  is  present.  The  perspira¬ 
tions  during  sleep  are  very  characteristic,  and,  in  young  children,  the 
lateness  of  teething  and  the  large  open  fontanelles  furnish  symptoms 
of  much  value.  These,  in  conjunction  with  enlargement  of  the  wrists 
jmd  a  tendency  to  throw  off  the  bed-clothes  at  night,  are  quite  sufficient 
to  establish  the  presence  of  the  disease.  In  older  children  the  char¬ 
acteristic  alteration  in  the  shape  of  the  head,  together  with  the  pers¬ 
piration  at  night,  and  the  enlargement  of  the  ends  of  the  bones,  will 
usually  suggest  the  existence  of  rickets  ;  and  the  diagnosis  will  be 
confirmed  when  any  signs  of  bending  of  the  bones  appear. 

Treatment  of  Rickets. — Treatment  must  be  directed  in  the  first 
place  to  the  alteration  of  the  conditions  from  which,  in  any  individual 
case,  the  disease  may  be  presumed  to  have  arisen.  Due  consideration 
must  be  given  to  the  diet,  and  the  possibility  of  deficiency  or  of  excess 
in  any  of  the  ordinary  constituents  of  food  must  be  kept  in  view'. 
Artificial  diets  of  children  are  often  much  wanting  in  cream  and  other 
fatty  substances,  the  cow’s  milk  which  usually  enters  into  them  not 
containing  normally  so  much  cream  as  human  milk,  and  being  often 
still  further  wanting  in  it  from  abstraction  before  the  milk  is  sold. 
Excess  of  farinaceous  food  is  also  a  frequent  error  of  diet,  giving  rise 
to  some  degree  of  gastric  and  intestinal  catarrh,  wTitli  a  tendency  to 
flatulence  and  diarrhoea.  Both  these  errors  not  unfrequently  conduce 
to  the  development  of  rickets.  Prolonged  suckling  on  the  part  of  the 


TREATMENT  OF  RICKETS 


273' 


mlother  sometimes  induces  rickets  in  the  baby  nursed,  as  the  milk  in 
time  becomes  watery  and  wanting  in  nourishment,  although  apparently 
satisfying  the  appetite  of  the  child. 

Deficiency  of  animal  food  in  older  children  tends  to  the  develop¬ 
ment  of  rickets,  especially  when  associated  with  unhealthy  surround¬ 
ings.  . 

Keeping,  then,  these  facts  in  view,  the  food  given  should  be  as 
nutritious  as  possible,  and  should  comprise  as  much  animal  food,  in¬ 
cluding  fats,  as  is  suitable  to  the  age  of  the  child.  Children  from  six 
months  to  a  year  old  may  be  given  cream,  animal  broths,  and  eggs,  in 
addition  to  milk  and  farinaceous  food  ;  while  the  diet  of  older  ones 
may  be  supplemented  with  fried  fat  bacon,  white  fish,  and  minced 
meat.  The  sanitary  condition  of  the  home  should  also  be  inquired 
into,  with  special  reference  to  unhealthy  arrangement  of  drains,  and 
impurities  in  the  water-supply.  The  ventilating  arrangements  of  the 
rooms  occupied  by  children  also  require  attention.  It  must  be  kept  in 
view  that  children  generally  spend  about  half  of  their  life  in  bed,  and 
it  is  quite  as  important  that  they  should  breathe  fresh  air  during  the 
night  as  during  the  day.  The  due  admission  of  air  to  bed-rooms  is  not 
unfrequently  overlooked,  and  sometimes  indeed  is  intentionally  pre¬ 
vented  with  the  object  of  maintaining  the  temperature  of  the  room. 
Such  a  condition  predisposes  strongly  to  the  development  of  rickets, 
and  calls  for  careful  attention.  In  Chapter  XVI.  will  be  found  some 
suggestions  as  to  the  best  method  for  securing  the  admission  of  fresh 
air  in  proper  quantity. 

When  all  possible  sources  of  injury  have  been  considered  and  reme¬ 
died,  various  hygienic  measures  are  of  value  in  effecting  arrest  and 
cure  of  the  disease.  Chief  among  these  is  the  daily  use  of  the  cold  or 
tepid  bath,  the  temperature  of  the  water  being  reduced  as  low  as  can 
be  done  consistently  with  obtaining  a  healthy  reactionary  glow,  and 
Avith  not  alarming  or  irritating  the  child.  When  children  dislike  a 
cold  or  tepid  bath,  or  tend  to  feel  cold  and  to  shiver  after  it,  the  cold 
douche  following  a  warm  bath  is  often  advantageously  substituted. 

Warm  clothing  is  also  of  much  importance  in  the  treatment  of 
rickets.  The  arms  and  legs,  as  well  as  the  whole  body,  should  be 
clothed  in  merino  or  flannel  both  day  and  night,  and  warm  external 
garments  proper  to  the  season  should  be  put  on  when  open-air  exercise 
is  taken. 

The  child  should  be  taken  out  of  doors  as  much  as  possible,  and 
Avlien  in-doors  a  room  exposed  to  sunshine  should  be  selected  for  its 
use,  when  available. 

One  of  the  difficulties  in  the  management  of  rickets  is  in  prevent¬ 
ing  walking,  when  the  child  has  arrived  at  an  age  at  which  it  can  use 
its  legs.  If  it  is  allowed  to  walk  much,  the  legs  are  almost  certain  to 


274 


COMMON  MALADIES  OF  CHILDREN. 


become  bent,  while,  if  not  permitted  to  walk  at  all,  it  loses  much  of 
the  open-air  exercise  so  essential  to  recover)'.  In  slight  cases  usually 
the  child  may  be  allowed  to  walk  for  a  little  time  during  the  day,  and 
taken  out  in  a  perambulator  at  other  times  ;  in  severe  cases  walking 
must  be  prohibited  altogether,  a  prohibition  most  easily  enforced  by 
encasing  the  legs  in  light,  ’well-padded  splints  which  project  one  or  two 
inches  below  the  soles  of  the  feet.  When  slight  bending  of  the  legs 
exists,  not  sufficient  to  necessitate  the  constant  wearing  of  splints, 
their  use  during  the  night  will  often  restore  the  symmetry  of  the 
limbs,  and  will  not  be  found  to  disturb  the  slumbers  of  the  child. 

Medicinal  treatment  is  of  subsidiary  importance  ;  the  one  really 
valuable  drug,  independently  of  those  used  to  meet  temporary  com¬ 
plicating  conditions,  is  cod-liver  oil,  which  should  be  given  in  doses 
as  large  as  the  child  is  able  to  digest. 

The  rectification  of  malformation  resulting  from  rickets  belongs 
to  the  domains  of  surgery,  and  is  a  department  in  which  great  ad¬ 
vances  have  been  made  in  recent  years.  By  surgical  means,  in  the 
present  day,  some  of  the  most  striking  deformities  of  the  legs  resulting 
from  this  disease  can  be  almost  entirely  rectified. 

[The  inventive  genius  of  American  surgeons  has  originated  the 
remarkable  advances  in  what  is  called  Orthopedic  Surgery,  by  which 
many  deformities  brought  about  by  scrofula  and  rickets  are  more  or 
less  remedied  ;  but  in  another  line  of  treatment  a  few  American  physi¬ 
cians  have  developed  even  more  important  resources  for  the  eradica¬ 
tion  of  those  blood  disorders  which  deform  the  body  and  its  members, 
and  lay  the  foundation  for  destructive  disease  of  its  vital  organs.  In 
no  domain  of  medical  practice  is  the  “  stitch-in-time  ”  policy  more  im¬ 
portant,  by  which  we  prevent  those  distortions  without  that  only  skil 
ful  surgery  can  partly  mitigate,  and  the  ravages  within  which  lead  to 
fatal  chronic  wasting  diseases.  See  page  1226.] 


CHAPTER  XX 


Management  of  Some  Emergencies. 

Bruises;  Sprains;  Burns  and  Scalds;  Incised  Wounds;  Arrest  of  Bleeding; 
Lacerated  Wounds;  Foreign  Bodies  in  Eye;  Foreign  Bodies  in  Ear  and 
Nose;  Bleeding  from  Nose;  Emergency  Basket;  Contents. 

Bruises. — Children  in  their  play  are  apt  to  receive  accidental  in¬ 
juries,  which  most  commonly  take  the  form  of  bruises.  A  bruise  is  a  dis¬ 
colored  swelling  resulting  from  a  knock  or  blow.  Both  the  swelling 
and  discoloration  arise  from  the  rupture  of  some  minute  blood-vessels 
underneath  the  skin,  and  the  consequent  escape  of  blood,  which  diffuses 
itself  to  some  distance  under  the  skin  around  the  site  of  the  injury.  At 
first  as  a  rule  of  a  deep  purple  color,  as  recovery  progresses  the  bruise 
usually  becomes  successively  blue,  bluish-green,  green,  and  yellow, 
afterward  returning  to  the  normal  color  of  the  skin.  Different,  parts 
of  the  bruise  may  recover  with  varying  rapidity,  so  that  two  or  three 
shades  of  color  may  be  present  at  the  same  time  on  different  parts  of 
the  surface. 

Uncomplicated  bruises  are  seldom  of  serious  importance,  the  only 
inconveniences  resulting  from  them  being  the  pain  and  stiffness  by 
which  they  are  usually  characterized,  and  the  unsightliness  of  their  ap¬ 
pearance,  when  on  any  conspicuous  part  of  the  bod}^. 

The  best  treatment  for  a  bruise  is  the  application  of  [the  Magnetic 
Ointment]  or  of  cold  in  some  form  as  soon  after  the  injury  as  possible. 
A  handkerchief  or  piece  of  lint  dipped  in  cold  water,  or  in  weak  spirit 
and  water,  may  be  employed  for  the  purpose,  or  when  available  some 
ice  may  be  used,  enclosed  in  a  gutta-percha  bag.  The  cold  applications 
should  be  continued  as  long  as  any  tenderness  to  touch  is  present,  after 
which  their  use  may  be  abandoned.  Very  little  more  need  be  done, 
as  the  bruise,  after  the  tenderness  has  disappeared,  will  gradually 
diminish  and  fade  ;  the  process  of  absorption  of  the  effused  blood  may, 
however,  be  expedited  somewhat  by  the  inunction  of  some  olive-oil  [or 
the  Magnetic  Ointment]  once  or  twice  daily.  The  propriety  of  rest 
should  be  decided  by  the  amount  of  pain  consequent  on  movement. 

Sprains  are  caused  by  undue  stretching  or  twisting  of  joints,  the 
ligaments  of  which  are  usually  partially  torn  by  the  strain.  There  is 
generally  also  some  stretching  of  other  tissues  in  the  neighborhood  of 


276  MANAGEMENT  OF  SOME  EMERGENCIES. 

the  joint,  with  rupture  of  minute  vessels  and  effusion  of  blood,  giving 
rise  to  the  characteristic  discoloration  of  bruising,  on  the  skin  over 
the  joint. 

There  is  often  considerable  difficulty  in  differentiating  severe 
sprains  from  other  injuries  of  joints,  and  this  difficulty  is  often  greater 
two  or  three  days  after  the  injury  than  immediately  after  ;  it  is  there¬ 
fore  desirable  that  all  severe  sprains  should  be  seen  by  a  medical  man 
as  early  as  possible.  Until  professional  advice  can  be  obtained,  the 
joint  affected  should  be  kept  at  perfect  rest,  and  in  as  elevated  a  posi¬ 
tion  as  possible  In  sprains  of  the  ankle  and  knee,  the  leg  should  be 
placed  on  a  chair  somewhat  higher  than  that  on  which  the  patient 
sits  ;  while  in  those  of  the  wrist  or  elbow,  the  arm  should  rest  on  a 
table,  or  on  a  pillow  if  the  invalid  is  laid  in  bed.  Cold  applications 
similar  to  those  used  for  bruises  should  be  employed.  Complete  rest  is 
obtained  most  easily  in  the  case  of  the  leg  by  tying  it  into  a  pillow,  the 
end  of  which  is  turned  up  against  the  back  of  a  chair,  or  the  foot  of  a 
bed.  The  leg  is  laid  along  the  pillow,  the  foot  being  pressed  against 
the  upturned  end,  and  one  or  two  handkerchiefs  or  small  lengths  of 
bandage  are  tied  with  moderate  tightness  round  pillow  and  leg  together, 
so  as  to  make  the  pillow  rise  on  each  side  of  the  leg,  and  encase  it  as  a 
splint.  There  is  usually  no  difficulty  in  maintaining  the  arm  at  rest 
laid  upon  a  pillow,  without  any  bandages.  Slight  sprains  such  as  are 
very  apt  to  occur  in  the  ankle  joints,  when  they  are  weak  or  have  been 
previously  strained,  are  best  treated  by  immediate  immersion  in  water 
as  hot  as  can  be  comfortably  borne.  The  immersion  should  be  con¬ 
tinued  for  ten  or  fifteen  minutes,  after  which  the  joint  should  be 
[rubbed  well  with  Magnetic  Ointment]  bandaged  and  used  with 
care  for  a  few  days.  Even  slight  sprains  are  prone  to  be  followed  by 
some  inflammation  of  the  joint  injured,  and  when  complete  recovery 
does  not  ensue  within  a  few  days  medical  advice  should  be  sought. 

Burns  and  Scalds  are  accidents  not  unfrequent  among  children. 
The  term  “burn”  is  usually  applied  to  injury  received  by  contact 
with  actual  flame,  or  with  some  solid  super-heated  body ;  while 
“scald”  is  generally  employed  to  describe  the  effect  produced  by 
waiter  or  other  fluid  at  high  temperature.  The  injuries  resulting  from 
burns  and  scalds  respectively  are  practically  similar,  differing  only  in 
this,  that  burns  are  usually  more  limited  in  area,  and  deeper  in  pene¬ 
tration,  than  scalds. 

Burns  and  scalds  occur  in  varying  degrees  of  intensity.  In  their 
slightest  form  they  appear  simply  as  slightly  reddened  patches  on  the 
skin,  tender  to  touch,  and  associated  with  sensations  of  heat.  In  a 
more  severe  form  the  skin  is  very  distinctly  reddened  and  somewhat 
swollen,  while  the  surface  here  and  there  is  raised  in  blisters,  which 
appear  as  pale  white  areas  on  the  red  bases.  Burns  to  this  extent  are 


BURNS:  CUTS;  WOUNDS. 


277 


•  y 


very  painful,  the  pain  being  of  a  severe  burning  character.  A  still 
further  degree  of  injury  causes  entire  destruction  of  the  skin,  which 
changes  into  a  yellow  or  blackened  sloughing  mass.  When  the  slough 
separates  an  ulcer  is  left,  and  this  on  healing  leaves  a  permanent 
cicatricial  mark  on  the  skin.  The  first  twTo  forms  described  heal  with¬ 
out  leaving  any  permanent  trace. 

Burns  and  scalds  are  dangerous  to  life  chiefly  in  proportion  to  the 
extent  of  their  superficial  area.  A  large  slight  burn  is  a  much  more 
serious  matter  than  a  small  severe  one  ;  and  the  amount  of  pain  is  not 
any  criterion  of  the  degree  of  danger.  In  some  cases  of  extensive  burn, 
the  collapse  and  shock  are  so  great  that  hardly  any  pain  is  felt  for  a 
time  ;  but  both  the  immediate  risk  and  the  danger  of  later  complica¬ 
tions  in  such  cases  are  very  great.  Burns  and  scalds  which  occupy  a 
considerable  part  of  the  body  very  frequently  give  rise  to  secondary 
complications,  more  especially  inflammation  of  the  intestines,  lungs, 
and  kidneys  ;  their  progress  should  therefore  be  watched  with  much 
anxiety. 

The  best  treatment  for  slight  burns  and  scalds  is  the  application 
[of  the  Magnetic  Ointment]  or  some  bland  oil,  such  as  olive  or  linseed 
oil,  soaked  into  lint  or  linen,  and  covered  with  oiled  silk  or  gutta-percha 
tissue.  When  the  burnt  surface  is  very  tender  to  touch  even  when 
dressed  in  this  wray,  cotton-wool  should  be  placed  outside  the  oiled  silk 
or  tissue,  and  the  whole  gently  bandaged.  When  oil  is  not  immediately 
available,  vaseline  spread  on  linen  or  lint  may  be  used,  and  wiien  this 
is  not  at  hand,  the  burn  should  be  thoroughly  powdered  writh  flour  or 
starch,  and  encased  in  cotton-wool  or  in  flannel.  The  same  treatment 
should  be  employed  for  severe  burns  until  medical  assistance  can.be 
obtained,  and,  when  the  child  seems  collapsed  and  w^eak,  a  little  diluted 
brandy  or  wrine  should  be  given  occasionally. 

Incised  Wounds. — Cuts  inflicted  by  a  sharp  instrument  are  mainly 
important  on  account  of  the  risk  of  excessive  bleeding ;  and  the  first 
point  in  the  treatment  is  the  arrest  of  the  flow  of  blood.  This  is 
generally  most  easily  effected  by  direct  pressure  upon  the  wound  with 
a  pad  of  dry  lint  or  linen,  kept  in  position  by  a  bandage.  Usually  no 
undue  amount  of  pressure  is  required  if  the  pad  is  properly  adjusted 
exactly  over  the  wound.  The  pad  should  vary  in  size  and  in  thickness 
in  proportion  to  the  length  and  depth  of  the  wround.  For  a  small  cut 
on  the  finger  one  about  half  an  inch  square,  and  an  eighth  of  an  inch 
in  thickness,  will  suffice  ;  for  a  severe  cut  on  the  hand  or  arm  or  leg, 
a  pad  of  two  inches  square,  and  of  half  an  inch  in  thickness,  may  be 
necessary.  The  breadth  of  the  bandage  should  be  regulated  in  accord¬ 
ance  with  the  part  to  which  it  is  to  be  applied.  Bandages  for  the 
fingers  should  not  much  exceed  half  an  inch  in  width,  and  for  the  hand 
a  width  of  one  inch  is  sufficient ;  for  the  arm  or  leg  a  bandage  two 


278 


MANAGEMENT  OF  SOME  EMERGENCIES. 


inches  broad  is  usually  most  convenient,  and  for  any  other  part  of  the 
body  one  of  three  or  four  inches  in  width. 

The  bandage  should  be  carefully  wound  round  the  part  as  often  as 
is  necessary  to  retain  the  pad  in  its  place,  but  should  not  be  employed 
in  such  a  way  as  to  conceal  any  further  bleeding  that  may  take  place. 
A  very  common  error  in  treating  wounds  is  to  cover  them  with  so 
many  bandages  that  a  great  quantity  of  blood  may  be  lost  before  it 
appears  on  the  surface  of  the  coverings.  It  may  always  be  assumed 
that  if  the  pad,  pressed  well  on  the  cut  by  a  few  turns  of  a  bandage, 
is  insufficient  to  arrest  the  bleeding,  no  amount  of  bandaging  external  to 
it  will  be  successful  in  doing  so  ;  one  bandage  alone  should  therefore 
be  used  to  maintain  the  pressure  of  the  pad  on  the  wound. 

When  pressure  in  the  manner  described  fails  to  arrest  the  bleeding, 
it  is  usually  best  to  separate  well  the  edges  of  the  cut,  and  plug  it 
thoroughly  with  small  strips  of  lint  or  linen,  putting  on  a  bandage 
with  moderate  tightness  to  maintain  the  plug  in  the  wound,  and  to 
exercise  some  pressure  upon  the  bleeding  surface.  When  bleeding  is 
arrested  by  the  pressure  of  a  pad,  the  pad  should  be  left  undisturbed 
for  at  least  twenty-four  hours,  after  which,  if  it  can  be  removed  easily, 
it  may  be  taken  off,  and  ordinary  adhesive  plaster  put  on  to  protect 
the  cut  and  keep  its  edges  together  while  it  heals.  When  the  pad  ad¬ 
heres  closely,  and  there  is  difficulty  in  removing  it,  it  is  best  to  leave 
it  in  its  place,  no  harm  resulting  if  it  is  left  in  position  until  it  becomes 
detached.  When  plugging  has  been  necessary,  the  plug  should  be 
removed  gently  in  from  six  to  twelve  hours,  the  sides  of  the  cut 
brought  together  and  maintained  in  position  by  adhesive  plaster,  and 
the  plaster  covered  by  a  small  pad  and  bandage.  In  using  adhesive 
plaster  to  hold  in  apposition  the  sides  of  the  cut,  long  narrow  strips 
should  be  used,  as  they  adhere  much  better  than  short  broad  ones. 

Lacerated  Wounds  or  Tears  are  generally  caused  by  some  blunt 
instrument  such  as  a  nail ;  sometimes  they  are  the  result  of  heavy  falls 
on  rough  surfaces.  They  very  seldom  bleed  much,  and  any  flow  of 
blood  that  may  exist  is  generally  very  easily  arrested.  As  from  the 
manner  of  its  production  a  lacerated  wound  is  often  rather  dirty,  the 
first  step  to  be  taken  in  treating  it  is  to  clean  it  thoroughly.  This  is 
best  done  by  holding  the  wound  over  a  basin,  and  pouring  a  stream  of 
tepid  waiter  over  it  from  a  height  of  six  to  twelve  inches,  until  the  sur¬ 
face  is  perfectly  clean.  When  clean  it  should  be  gently  dried  by 
pressing  against  it  a  soft  towel,  after  which  the  raw  surface  should  be 
dressed  with  lint  soaked  in  carbolized  oil,  of  the  strength  of  one  part 
of  carbolic  acid  to  thirty  parts  of  olive-oil  [or  Magnetic  Ointment.]  The 
lint  should  be  covered  with  oiled  silk  or  gutta-percha  tissue,  and  the 
dressing  maintained  in  position  by  a  few  turns  of  a  bandage.  The  wash¬ 
ing  and  dressing  of  the  wound  should  be  repeated  once  or  twice  daily. 


FOREIGN  BODIES  IN  EYE,  EAR  OR  NOSE. 


279 


Foreign  Bodies  in  the  Eye,  such  as  particles  of  dust  or  grit, 
c/eate  much  irritation,  with  redness  and  flow  of  tears,  and  should 
always  be  removed  as  early  as  possible.  In  the  vast  majority  of  cases 
where  a  foreign  body  enters  the  eye,  it  becomes  adherent  to  the  inner 
surface  of  the  upper  eyelid  ;  and  the  irritation  and  pain  resulting  from 
its  presence  are  due  to  its  being  rubbed  over  the  sensitive  surface  of  the 
eye,  each  time  the  eyelid  is  moved  in  winking.  In  some  few  cases  the 
irritating  particle  lies  on  the  inner  surface  of  the  lower  eyelid  ;  some¬ 
times  it  is  to  be  seen  imbedded  in  the  clear  part  of  the  eye  itself. 

When  situated  within  the  lower  eyelid  there  is  no  difficulty  what¬ 
ever  in  its  removal.  The  eyelid  should  be  drawn  down  slightly  with 
the  finger,  when  the  foreign  body  will  be  seen,  and  can  be  removed 
easily  with  the  corner  of  a  handkerchief,  or  with  a  small  camel’s-liair 
brush. 

When,  as  is  most  commonly  the  case,  the  foreign  body  is  adherent 
to  the  inner  surface  of  the  upper  eyelid,  the  most  satisfactory  method 
of  removing  it  is  by  everting  the  eyelid.  This  eversion,  which  is  often 
performed  as  a  trick  by  schoolboys,  can  usually  be  effected  with  little 
difficulty,  if  a  child  is  patient  and  obedient.  The  eyelid  is  first  care¬ 
fully  dried,  and  then  gentle  pressure  is  made  on  it  with  a  blunt  point, 
such  as  the  point  of  a  lead  pencil,  about  one-tliird  of  an  inch  above  the 
margin  of  the  eyelid,  just  under  the  eyebrow.  The  pressure  causes  the 
margin  of  the  eyelid  to  project  a  little  outward  from  the  eye,  so  that 
it  can,  along  with  a  few  eyelashes,  be  caught  within  the  finger  and 
thumb  ;  a  gentle  twist  upward  then  completes  the  little  operation. 
After  the  foreign  body  has  been  removed  the  eyelid  is  very  easily  re¬ 
placed  by  turning  it  downward  again.  When  eversion  cannot  be 
effected,  the  foreign  body  may  sometimes  be  removed  by  drawing  the  up¬ 
per  eye-lkl  well  downward  over  the  lower  eyelashes,  and  allowing  it  to 
recede  again  two  or  three  times  successively,  thus  making  use  of  the 
lower  eyelashes  as  a  brush  to  sweep  the  inner  surface  of  the  upper  eye¬ 
lid.  If  the  foreign  body  is  seen  to  be  impacted  in  the  clear  surface  of 
the  eye,  the  child  should  be  taken  to  a  medical  man  at  once,  as  the 
operation  of  removal  is  a  delicate  one,  and  much  injury  may  result  * 
from  unskilful  interference. 

Foreign  Bodies  in  the  Ear  and  Nose. — Children  not  unfre- 
quently  push  small  objects,  such  as  peas,  cherry-stones,  and  small 
pieces  of  pencil,  into  the  openings  of  the  ear  and  nose,  and  find  them¬ 
selves  unable  afterward  to  remove  them.  Sometimes,  perhaps  from 
fear  of  punishment,  sometimes  from  forgetfulness,  they  make  no 
mention  of  what  they  have  done,  and  the  first  indication  of  the  pres¬ 
ence  of  the  foreign  body  may  be  some  inflammation  of  the  cavity  in 
which  it  is  situated,  with  perhaps  a  little  swelling,  and  usually  some 
discharge  of  matter.  When  the  presence  of  any  foreign  body  is  mani- 


28o 


MANAGEMENT  OF  SOME  EMERGENCIES. 


fest.  its  removal  should  be  accomplished  as  soon  as  possible,  but  must 
be  undertaken  with  some -care,  on  account  of  the  risk  of  injuring 
further  the  already  irritated  organs. 

When  a  foreign  body  is  detected  in  the  ear,  it  should  be  removed 
by  syringing  with  warm  water,  and  should  not  be  manipulated  in  any 
way.  A  strong  glass  or  a  brass  syringe  should  be  used,  and  while  a 
bowl  is  held  under  the  ear  to  receive  the  water  returning,  the  current 
from  the  syringe  should  be  directed  along  the  roof  of  the  passage  of 
the  ear.  If  the  foreign  body  is  not  very  tightly  fixed  in  the  ear,  it  will 
usually  be  pushed  out  by  the  returning  current  after  a  few  minutes’ 
syringing.  When  it  cannot  be  removed  in  this  wTay,  medical  assistance 
should  be  sought,  as  much  danger  may  ensue  from  neglect. 

A  foreign  body  in  the  nose  may  sometimes  be  expelled  by  causing 
the  child  to  sneeze,  either  by  the  use  of  a  little  snuff,  or  by  gentle  tick¬ 
ling  of  the  interior  of  the  nostril.  If  this  is  not  effective,  it  can  fre¬ 
quently  be  removed  by  the  aid  of  a  hair  pin  very  slightly  altered  in 
shape.  A  hair  pin  of  moderate  size  is  compressed  sufficiently  to  allow 
the. curved  end  to  enter  the  nostril  easily.  This  end  is  then  bent  slight¬ 
ly  so  as  to  form  a  small  hook,  which  should  be  gently  inserted  under 
the  foreign  body,  and  pushed  on  until  it  hooks  behind  it.  If  the  hair¬ 
pin  is  now  slowly  withdrawn,  while  at  the  same  time  its  outer 
end  is  gradually  lowered  toward  the  mouth,  the  foreign  body  will 
usually  come  out  lying  in  the  loop.  Care  must  be  taken  in  inserting 
the  hairpin  that  the  foreign  body  is  not  pushed  backward  toward 
the  throat. 

Bleeding  from  the  Nose  is  not  uncommon  in  children,  but  rarely 
occurs  to  such  an  extent  as  to  excite  anxiety.  When  it  appears  very 
occasionally,  it  may  be  the  result  of  some  temporary  disorder  of  the 
stomach,  or  of  some  local  irritation  of  the  lining  membrane  of  the  nose 
due  to  cold  ;  w  hen  it  recurs  frequently  it  is  generally  associated  with 
some  unhealthy  condition  of  the  posterior  part  of  the  nostrils,  or  of 
the  throat. 

To  arrest  the  bleeding  the  child  should  be  placed  on  a  chair  wfith 
its  head  well  throwm  back,  and  its  arms  held  above  its  head,  and  a 
handkerchief  dipped  in  cold  water,  or  a  small  piece  of  ice,  should  be 
laid  on  the  forehead  near  the  base  of  the  nose.  If  these  means  fail 
to  stop  the  hemorrhage,  the  nostrils  may  be  gently  syringed  with  cold 
or  iced  water ;  this,  howrever,  is  a  somewhat  painful  remedy,  and  is 
seldom  required.  When  frequent  recurrence  indicates  the  probability 
of  some  permanent  abnormal  condition,  the  child  should  be  placed 
under  medical  supervision. 

The  Mother’s  Emergency  Basket. — In  view  of  the  possibility 
of  occasional  accidents  in  households,  it  is  very  convenient  for 
mothers  to  have  a  small  emergency  basket  containing  articles  likely 


EMERGENCY  BASKET. 


281 


to  be  useful  on  such  occurrences, 
should  consist  of : 

Some  lint. 

Some  cotton-wool. 

Some  old  linen. 

A  few  prepared  bandages,  vary¬ 
ing  in  width  from  one-half 
inch  to  three  inches. 

A  roll  of  adhesive  plaster. 

Some  safety-pins. 

Ordinary  needles  and  thread. 

[And  a  pot  of 


The  contents  of  such  a  basket 

One  or  two  surgical  needles,  and 
silk  thread. 

Some  oiled  silk,  or  gutta-percha 
tissue. 

A  pair  of  scissors. 

A  nurse’s  dressing  forceps. 

A  bottle  of  carbolized  olive-oil  of 
the  strength  of  one  part  of 
carbolic  acid  to  thirty  of  oil. 
Magnetic  Ointment]. 


PART  IV. 

LATER  MARRIED  LIFE. 
CHAPTER  XXL 


The  Menopause. 

«  V 

Change  of  Life;  Age  at  which  it  Occurs;  Manner  of  Occurrence;  Discomforts 
attending  Menopause;  Affections  of  Head;  of  Digestion;  Mental  Irrita¬ 
bility;  Depression  of  Spirits;  Physical  Alterations;  Occasional  “Flood¬ 
ings  Treatment  of  Various  Symptoms. 

The  terms  menopause  and  change  of  life  are  usually  employed 
synonymously  to  indicate  the  period  in  a  woman’s  life  during  which 
some  marked  constitutional  alterations  take  place,  of  which  the  most 
striking  feature  is  the  cessation  of  the  menstrual  period. 

Women  in  normal  health  generally  menstruate  regularly  until  they 
attain  an  age  varying  from  forty-two  to  fifty  years,  the  monthly 
periods  only  intermitting  during  gestation  and  suckling  ;  then  most 
commonly  some  irregularity  in  the  periods  manifests  itself  for  some 
months  or  even  years  before  complete  cessation  takes  place.  Exception¬ 
ally,  the  menstrual  periods  cease  at  once  without  any  previous  ir¬ 
regularity. 

Generally  the  irregularity  takes  the  form  of  arrest  of  the  menstrual 
flow  for  one  or  two  months,  followed  by  a  period  somewhat  more 
profuse  than  usual,  and  again  by  cessation  for  several  months.  Not 
unfrequently  the  cessation  is  preceded  by  several  periods  of  excessive 
menstruation,  and,  after  a  few  months  of  arrest,  two  or  three  suc¬ 
cessive  menstrual  periods  may  again  appear  of  exceptional  duration 
and  amount.  In  other  instances  again  the  menstrual  flow  becomes  pro¬ 
gressively  less  at  each  period,  until  it  ceases  altogether. 

Whatever  the  conditions  may  be  under  which  the  menstrual  flow 
ceases  permanently,  the  cessation  is  as  a  rule  preceded  or  accompanied 
by  various  symptoms  affecting  to  some  extent  both  the  body  and  the 
mind.  Foremost  among  these  are.  usually  uncomfortable  sensations 


CHANGE  OP  LIFE. 


283 

affecting  the  head ;  frequent  headaches,  occasional  giddiness,  and 
paroxysmal  flushings  of  the  face  being  common  at  this  period  of  life. 
Sudden  sensations  of  heat  affecting  the  whole  body  are  often  com¬ 
plained  of,  and  attacks  of  palpitation  of  the  heart  occasionally  occur. 
Neuralgia  in  various  situations  not  unfrequently  presents  itself. 
Troubles  of  digestion  are  also  experienced,  more  especially  flatulence 
and  heart-burn.  Mental  irritability,  depression  of  spirits,  and  hyper¬ 
sensitiveness  often  characterize  this  period  of  life,  varying  in  their 
intensity  from  day  to  day,  and  sometimes  disappearing  for  days,  only 
to  return  in  a  more  pronounced  form.  Some  fulness  and  enlargement 
of  the  breasts,  with  sensations  of  discomfort,  tenderness,  and  even 
pain  are  often  remarked ;  and  sometimes  a  feeling  of  distention  of  the 
whole  body  is  experienced,  with  enlargement  of  the  abdomen,  partly 
due  to  flatulence  and  partly  to  deposition  of  fat. 

The  cessation  of  menstruation,  together  with  enlargement  and 
pain  of  the  breasts  and  disturbance  of  digestion,  not  unfrequently 
induces  the  supposition  of  pregnancy  ;  and  for  the  first  month  or  two 
after  the  cessation  it  is  sometimes  impossible  to  be  certain  that  preg¬ 
nancy  does  not  exist.  One  factor  in  the  distinction  is  that  the  morn¬ 
ing  sickness  of  pregnancy  never  presents  itself  in  arrest  of  menstrua¬ 
tion  due  to  the  access  of  the  change  of  life.  There  is  no  doubt,  how¬ 
ever,  that  in  many  cases  the  differential  diagnosis  is  difficult,  if  not 
impossible,  without  a  thorough  examination  of  the  condition  of 
the  womb. 

Irregular  symptoms  connected  with  the  menstrual  flow  are  so 
common  at  this  period  of  life,  that  women  are  occasionally  apt  to  con¬ 
sider  all  abnormal  conditions  presenting  themselves  as  referable  to 
the  change  of  life,  and  thus  to  endanger  their  health  by  the  neglect  of 
attention  to  remediable  maladies.  One  of  the  most  common  troubles 
thus  neglected  is  occasional,  severe  “flooding”  from  the  womb.  Not 
unfrequently  this  is  due  not  to  the  age  which  the  patient  has  attained, 
but  to  some  local  disorder  of  the  womb,  which  may  or  may  not  be 
directly  associated  with  the  particular  period  of  life  reached.  If 
allowed  to  recur  frequently  without  any  steps  being  taken  for  its  arrest, 
a  very  much  weakened  state  of  health  may  be  induced,  which  may  not 
only  temporarily  render  the  invalid  unfit  for  her  usual  duties,  but  may 
expose  her  to  attacks  of  dangerous  illness.  It  is  very  unwise  to  delay 
obtaining  medical  advice  when  abnormal  symptoms  of  this  character 
occur.  [See  page  1226.] 

Treatment  of  the  uncomfortable  symptoms  accompanying  the 
period  of  the  menopause  must  be  mainly  directed  to  regulation  of  diet 
and  mode  of  life,  and  promotion  of  secretions  which  will  to  some  extent 
serve  as  substitutes  for  the  arrested  menstrual  flow.  The  diet  should 
i  e  light  and  unstimulating,  little  meat  food  being  taken,  and  that 


284 


THE  MENOPAUSE. 

mainly  consisting  of  fish  or  white  flesh,  in  preference  to  beef  or  mutton. 
Stimulants  should  be  used  in  great  moderation,  if  at  all  ;  as  a  rule  total 
abstinence  from  all  alcoholic  fluids  is  best,  hut  in  some  cases  a  little  light 
wine  at  meals  may  be  taken.  Regularity  of  exercise  in  the  open  air  is 
of  importance,  and  warm  clothing  should  always  be  worn,  notwith¬ 
standing  the  tendency  to  sudden  flushes  of  heat.  Tepid  baflis,  once  or 
twice  daily,  often  give  much  comfort. 

Medicinally,  much  relief  is  often  afforded  by  the  systematic  em¬ 
ployment  of  some  saline  laxative  medicine.  Natural  waters  may  be 
taken  in  moderate  doses  every  morning,  or  on  alternate  mornings  ;  or 
saline  medicines,  such  as  effervescing  citrate  of  magnesia  or  effer¬ 
vescent  laxative  salts,  may  be  made  use  of  [and  an  occasional  anti-bil¬ 
ious  pill  is  often  of  much  service]. 

Healthy  occupation  for  the  mind  is  of  much  importance  at  this 
period  of  life  ;  its  troubles  and  discomforts  are  borne  much  more  easily 
when  the  thoughts  are  distracted  by  external  duties  and  pursuits,  than 
when  allowed  to  concentrate  themselves  unduly  on  the  disagreeable 
sensations  and  other  sources  of  disturbance  incidental  to  the  change  of 
life.  It  is,  after  all,  a  period  of  comparatively  short  duration,  and 
when  borne  with  courage  and  determination  emerges  eventually  into 
the  mellow  ripeness  of  elderly  life,  when  the  trials  and  responsibilities 
which  have  been  foreshadowed  in  the  earlier  pages  of  this  work  are 
regarded  in  the  golden  haze  of  a  memory  which  recalls  the  pleasures, 
while  it  forgets  the  troubles,  associated  with  the  past. 

[This  is  the  end  of  a  book  full  of  facts  and  good  advice,  but  there 
may  be  readers  who  will  think  of  something  they  wish  to  ask  that  this 
book  does  not  cover.  They  should  then  look  through  the  companion 
volume,  written  by  Dr.  Foote  (see  last  pages  of  advertising) ;  and  if  the 
instruction  desired  is  not  to  be  found  therein,  then  the  office  of  free 
consultation  holds  good,  and  Dr.  Foote  stands  ready  to  write  a  free 
letter  of  advice  in  reply  to  any  well-written  inquiry  stating  plainly  just 
what  the  consultant  is  looking  for.  Thus  the  publishers  try  to  make 
these  books  entirely  satisfactory,  and  complete  any  possible  deficiencies. 
The  doctor’s  address  and  offer  of  consultation  may  be  found  on  page 
1226.] 


INDEX 


A 

ABDOMINAL  belts,  86. 

Abnormal  sense  of  hunger,  22,  23. 
Abortion,  44. 

Abscess  of  breast,  94. 

- treatment  of,  95. 

Abscess  of  ear,  219.  *  . 

Accommodation  of  nurse,  64. 

Additions  to  milk  diet,  150, 151. 
Administration  of  enemas,  33. 
Afterbirth,  description  of,  72. 
After-pains,  77. 

Aids  to  convalescence  from  confine¬ 
ment,  84. 

Alcohol,  craving  for,  13. 

Amount  of  sleep  for  children,  108. 
Animal  food,  solid,  151,  152. 

Antiseptic  fluids,  67. 

Aperients  after  confinement,  78. 
Application  of  binder  after  confine¬ 
ment,  82. 

Applications,  external,  180. 

Areola  of  breast,  24. 

- enlargement  of,  24. 

- pigmentation  of,  24. 

- secondary,  25. 

Artificial  food,  temperature  of.  142. 

- means  of  exercise,  158. 

- sources  of  heat,  175. 

- sponges,  66. 

Ascarides,  265. 

Ass’s  milk,  149. 

Astigmatism,  167. 

B 

Baby’s  basket,  6& 

Bags,  ice,  184. 

Bandages  for  legs,  40. 

Bapkins,  105. 

Basket,  baby’s,  68. 

- emergency,  280. 

Bassinette,  68. 

Bath,  temperature  for  infant,  120. 

- temperature  for  invalid,  177. 

Bathing  during  pregnancy,  42,  43. 

Baths  for  infants,  127 


Bed-bath,  65. 

Bed-pan,  65. 

Bed-room,  choice  of,  63. 

- cleaning  of,  64. 

- heating  of,  64. 

Belts,  abdominal,  36. 

- after  confinement,  67. 

Bicuspid  teeth,  114. 

Binder,  67. 

- application  after  confinement,  82. 

- in  pregnancy,  43. 

- in  sleeplessness,  43. 

Bleeding  from  nose,  280. 

- from  stump  of  cord,  121. 

- from  incised  wounds,  277. 

Blood,  discharge  of,  in  premature  con¬ 
finement,  58. 

Boots,  children’s,  131. 

Bottles,  feeding,  142. 

Bowel,  prolapse  of,  238. 

Bowels,  cold  affecting,  232. 

- treatment  of,  233. 

Bran  poultices,  181. 

Bread  poultices,  182. 

Breast,  abscess  of,  94. 

- discomfort  in,  89,  90. 

- discomforts  of,  93. 

- enlargement  of,  24. 

- fulness  of,  89. 

- fulness  of,  after  miscarriage,  54 

- inflammation  of  infant’s.  -93. 

- inflammation  of  mother’s,  9*. 

Breast-milk,  insufficiency  of.  138. 
Bronchial  catarrh,  214. 

Bronchitis,  214,  231. 

- treatment  of,  216,  234. 

Bruises,  275. 

Burns  and  scalds,  276. 

Bursting  of  waters,  72. 

C 

\ 

Calisthenics,  158. 

Canine  teeth,  110, 114. 

Capacity  of  infant’s  stomach,  187. 
Carbolic  acid,  67. 

Carbolized  vaseline,  67. 


286 


INDEX. 


Caro  of  breasts  during  weaning,  99. 

- of  umbilical  cord,  121. 

Catarrh,  bronchial,  214. 

Causes  of  miscarriage,  45. 

— *-  of  premature  confinement,  56. 

- of  sleeplessness,  43. 

Cautions  referring  to  miscarriage,  54. 
Cessation  of  menstruation,  19. 

Change  of  circumstances  after  mar¬ 
riage,  15. 

- of  life,  282. 

Characteristics  of  cow’s  milk,  141. 
Chicken-pox,  249. 

Child-bearing  period,  12. 

Child-crowing,  217. 

- treatment  of,  217. 

Chill,  symptoms  of,  230. 

- treatment  of,  233. 

Choice  of  bedroom,  63. 

Chloroform  in  confinement,  75. 

Cleaning  of  bedroom,  64. 

Cleanliness  of  invalid,  177. 

- of  sick-room,  172. 

Cleanly  habits  of  infant,  128. 

Clinical  thermometer,  170, 171. 

Clothing  of  older  children,  129. 

- of  infants,  122. 

- of  invalids,  177. 

Club-foot,  163. 

Coal  fires,  175. 

Coffee  in  diet  of  children,  153. 

Cold  affecting  bowels,  232. 

- affecting  stomach,  232. 

- applications,  183. 

- bathing  during  pregnancy,  43. 

- disorders  due  to,  229. 

- during  dentition,  213. 

- in  the  head,  230. 

- in  larynx,  230. 

- in  throat,  230. 

- treatment  of,  233. 

Colic  during  dentition,  213. 
Companionship,  value  of,  15. 
Compresses,  186. 

Condensed  milk,  140. 

Condy’s  fluid,  67. 

Confinement,  70. 

- aperients  after,  78. 

- convalescence  from,  76. 

- diet  after,  77. 

- discharge  after,  79. 

- douching  after,  80. 

- first  stage  of,  72. 

- food  during,  72, 


Confinement,  normal  progrww  aft*r,  8*. 

- position  after,  81. 

- premature,  66. 

- —  preparations  for,  61. 

- preparation  of  bed  for,  68. 

- probable  date  of,  20,  21. 

- second  stage  of,  73. 

- third  stage  of,  74. 

Congenital  defects,  262. 

Constipation,  239. 

- diet  in,  239. 

- during  pregnancy,  31. 

- enemas  in,  241. 

— -  in  infants,  202. 

- treatment  of,  31,  32,  202,  239. 

Constitutional  diseases,  266. 

Contents  of  womb  before  miscarriage, 
51. 

Convalescence  from  confinement,  76. 

- from  miscarriage,  53. 

- diet  during,  54. 

Convulsions,  218. 

- treatment  of,  218. 

Cord,  umbilical,  separation  of,  192. 
Coronal  suture,  103. 

Cough  during  dentition,  213. 
Counter-irritation,  treatment  by,  186. 
Course  of  premature  confinement,  57. 
Cow’s  milk,  fresh,  139. 

- condensed,  140. 

Cradle,  68,  124. 

Craving  for  alcohol,  13. 

- for  food  in  pregnancy,  22,  23. 

- for  unwonted  articles  of  food,  23. 

Croup,  false,  214. 

Curvature  of  spine  in  girls,  159. 

D 

Dancing  as  an  exercise,  158. 

Defects,  congenital,  162. 

- of  eyes,  166. 

Deficiency  of  fat  in  diet,  153. 

Dentition,  disorders  of,  210. 

- first,  109. 

- nervous  system  during,  210. 

- second.  113. 

Depression  of  nipple,  87. 

Desquamation  of  skin  of  infants,  194. 

- of  skin  after  confinement,  83. 

- stage  of,  249. 

Development  of  child,  102. 

- lacteal  functions  of  mother,  86. 

- of  walking  powers  of  child,  110. 

Diapers  for  infant,  68, 123. 


INDEX 


287 


Diapers  for  mother,  66. 

Diarrhoea  In  children,  237. 

- during  dentition,  213. 

- in  infants,  197. 

Diathetic  diseases,  266. 

Diet  after  confinement,  77. 

■ - during  convalescence  from  mis¬ 

carriage.  54. 

- during  pregnancy,  30. 

- importance  of  regularity  in,  16. 

- in  threatening  miscarriage,  49. 

Difficulties  of  digestion  in  infants,  137. 
Digestion,  difficulties  of,  in  infants,  137. 

- painful,  in  infants,  92. 

Digestive  organs,  disorders  of,  236. 
Dilution  required  by  cow’s  milk,  139. 
Diphtheria,  precautions  relating  to,  227. 
Diphtheritic  inflammation,  225. 
Discharge  after  confinement,  74,  79. 

- after  miscarriage,  53. 

- of  blood  in  miscarriage,  47. 

• - of  blood  in  premature  confine¬ 

ment,  58. 

- fetor  of,  after  confinement,  79. 

- from  ear,  221. 

- vaginal,  42. 

Discomfort  in  breasts,  90,  93. 

Disease  of  womb  as  cause  of  mis¬ 
carriage,  46. 

Disinfectants,  abuse  of,  191. 

- in  infectious  disease,  190. 

Disorders  of  dentition,  210. 

- of  pregnancy,  management  of,  29. 

Distention  of  veins  of  leg,  39. 

Disuse  of  faculties,  results  of,  156. 
Doctor,  selection  of,  61. 

Douche,  vaginal,  65. 

Douching  after  confinement,  80. 
Drainage  of  house,  64. 

Draw-sheet,  69. 

Drill,  military,  158. 

Dry  heat,  application  of,  183. 

Duration  of  nursing,  98. 

- of  pregnancy,  20. 

- of  rest  after  miscarriage,  53. 

Duties  of  a  nurse,  168. 

—  of  married  life,  11. 

E 

Ear,  abscess  of,  219. 

- discharge  from,  221. 

- foreign  bodies  in,  279. 

- syringing  of,  189. 

Earache,  221, 


Early  miscarriage,  44. 

- motherhood,  76. 

Eczema,  246. 

Effects  of  rheumatism,  13,  267. 

- of  stimulants,  17. 

Effort  and  rest,  157. 

Elastic  stockings,  40. 

Emergencies,  management  of,  275. 
Emergency  basket,  280. 

Enema  syringe,  33. 

Enemas,  administration  of,  33. 

- composition  of,  34. 

- in  constipation,  241. 

- quantity  of  fluid  in,  34. 

Enlarged  lymphatic  glands,  268. 

- tonsils,  effects  on  respiration,  228. 

Enlargement  of  areola  of  breasts,  24. 

- of  breasts,  24. 

Errors  in  children’s  diet,  153. 

Eruption,  stage  of,  249. 

Eruptions,  non-infectious,  241. 
Eruptive  fevers,  infectious,  247. 
Erythema,  200. 

- papulatum,  241. 

Excess  of  farinaceous  food  in  diet,  153. 

- of  nitrogenous  food  in  diet,  154. 

Excretion  from  bowels  of  infant,  104. 
Exercise,  artificial  means  of,  158. 

- bicycle,  16. 

- out-door,  126. 

- riding,  16. 

- rowing,  16. 

- walking,  16. 

External  applications  in  children,  180. 
- piles,  41. 

- signs  of  pregnancy,  19. 

Eye,  application  of  lotion  to,  189. 

- defects  of,  166. 

- foreign  bodies  in,  279. 

Eyelids,  inflammation  of,  204. 

P 

Faintness,  35. 

False  croup,  214. 

- treatment  of,  216. 

False  pains,  71. 

Family  syringe,  65. 

Farinaceous  foods,  143. 

- —  excess  of,  153. 

Fat,  deficiency  of,  158. 

Feeding  bottles,  142. 

Feeding  by  hand,  144. 

- cup,  67. 

Fees,  medical,  62. 


288 


INDEX. 


Fees  of  monthly  nurses,  63. 

Fever  as  cause  of  miscarriage,  46. 
Feverishness  after  confinement,  84. 
Fevers,  infectious  eruptive,  247. 

- stages  of  infective,  249. 

Fires,  coal,  175. 

- gas,  176. 

First  dentition,  109. 

- stage  of  confinement,  70. 

Fissures  on  nipple,  89. 

Flannel,  qualities  of,  177. 

“  Flooding  ”  after  confinement,  79. 
Florence  Nightingale,  aphorism  of,  172. 
Fetor  of  discharge  after  confinement, 
79,  84. 

Fomentations,  180. 

Fontanelles,  103. 

Food  during  confinement,  72. 

- of  invalids,  178. 

Foods,  farinaceous,  143. 

Foreign  bodies  in  ear,  279. 

- in  eye,  279. 

- in  nose,  279. 

Formation  of  moral  character,  161. 
Frequency  of  suckling,  91,  137. 

Fresh  air,  value  of,  for  children,  125. 
Friction,  how  to  apply,  187. 

Frontal  suture,  103. 

Fulness  of  breasts  after  confinement, 
89. 

- after  miscarriage,  54. 

- of  stomach,  sense  of,  23. 

G 

Garters,  131. 

Gas  fires,  176. 

- effects  of,  176. 

Gastric  derangements  of  pregnancy,  22. 
General  care  of  child,  120. 

Glands,  enlarged  lymphatic,  268. 

- scrofulous,  269. 

Glycerine,  injection  of,  34. 

- syringe,  35. 

Goat’s  milk,  150. 

Gravel  in  urine,  201. 

Growth  of  infant,  105, 106. 

Gums,  affections  of,  211. 

H 

Hemorrhage  after  confinement,  79. 

- from  wounds,  277. 

Haemorrhoids,  40 
- treatment  of,  42. 


Hand-feeding,  144: 

Harelip,  164. 

Heaith  of  the  mind,  17. 

Heartburn,  23. 

- treatment  of,  30. 

Heat,  application  of  dry,  183. 

- artificial  sources  of,  175. 

Heating  of  bedroom,  64. 

Heat-spots,  241. 

Heights  of  children,  106. 

Helps  to  convalescence  after  confine¬ 
ment,  84. 

Hereditary  tendency  to  indigestion,  13. 

- to  rheumatism,  13. 

- transmission  of  disease,  13. 

Hernia,  164. 

- inguinal,  165. 

- umbilical,  165,  193. 

Horseback  exercise,  16. 

Humanized  milk,  146. 

Hygiene  of  invalid,  172. 

- of  sick-room,  172. 

Hypermetropia,  167. 

I 

Ice-bags,  184. 

Ice,  how  to  break,  185. 

- how  to  keep,  185. 

Imitative  powers  of  children,  14. 
Imperfections  of  vision,  166. 
Imperforate  condition  of  lachrymal 
ducts,  166. 

Importance  of  rest,  159. 

Incised  wounds,  277. 

Incisor  teeth,  109, 113. 

Increase  in  size  of  abdomen,  27. 

- management  of,  36. 

Incubation,  stage  of,  249. 

Indications  of  intelligence  in  infants,  107 

- of  threatening  miscarriage,  47. 

Indigestion,  acute,  236. 

- chronic,  236,  237. 

- in  infants,  92. 

- signs  of,  in  infants,  92,  93. 

- treatment  of,  237. 

Infants’  breasts,  inflammation  of,  198. 

- difficulties  in  sucking,  136. 

Infant  life,  minor  troubles  of,  192. 
Infectious  diseases,  disinfectants  in,  190. 

- diseases,  isolation  during,  190. 

- eruptive  feyers,  247. 

- fevers,  stages  of,  249. 

Inflamed  piles,  treatment  of,  42. 
Influence  of  maternal  example,  13. 


INDEX. 


Inguinal  hernia,  165. 

Inherited  tendencies,  13. 

Injection  of  glycerine,  34. 

Insufficiency  of  breast-milk,  90,  139. 
Intelligence  in  infants,  113. 

Intertrigo,  200,  201. 

Invalid,  cleanliness  of,  177. 

- clothing  of,  177. 

- food  of,  178. 

- washing  of,  177. 

Invasion,  stage  of,  249. 

Irritant  plasters,  187. 

Irritation,  vaginal,  42. 

Isolation  in  infectious  diseases,  190. 
Itch,  264.  '  - 

Itching  from  vaginal  discharge,  42. 

J 

Jaundice,  194. 

K 

Kingsley,  Rev.  Charles,  14. 

L 

Lacerated  wounds,  278. 

Lachrymal  ducts,  closure  of,  166,  205. 
Lacteal  functions,  development  of,  87. 
Later  married  life,  282. 

Laxative  medicines,  241. 

Light  of  sick-room,  176. 

Linia?  albicantes,  37. 
liniments,  187. 

Linseed  poultices,  181. 
^ong-sightedness,  167. 

Lotion,  application  to  infant’s  eyes,  204. 

- for  vaginal  discharge,  42. 

Lotions,  189. 

Lymphatic  glands,  enlarged,  268. 

M 

Management  of  threatening  miscar¬ 
riage,  50. 

Marks,  mothers’,  162. 

Married  life,  duties  of,  11. 

- life,  later,  282. 

- life,  responsibilities  of,  11. 

Maternal  example,  influence  of,  14. 
Maternity,  probability  of,  12. 

Measles,  254. 

Meconium,  135. 

>fedical  attendant,  selection  of,  61. 

- —  fees,  62. 

. —  practices,  62, 


289 

Menopause,  282.  . .  „ * 

Menstrual  discharge  in  girls,  115. 
Menstruation,  cessation  of,  19. 

- recommencement  of,  98. 

Mental  anxiety  as  cause  of  miscarriage, 
46. 

- health  at  puberty,  118. 

- peculiarities  during  dentition,  220. 

- training,  160. 

Merino,  qualities  of,  177. 

Micturition,  crying  during,  202. 

- painful,  202. 

Military  drill,  158. 

Milk,  ass’s,  149. 

- condensed,  140. 

- goat’s,  150. 

- humanized,  146. 

- peptonized,  148. 

- sterilized,  146. 

- teeth, 110. 

Mind,  health  of  the,  17. 

Minor  troubles  of  life,  18. 

Miscarriage,  44. 

- causes  of,  45. 

- - convalescence  from,  53. 

- discharge  of  blood  in,  47. 

- indications  of,  47. 

- management  of,  50. 

- preventive  treatment  of,  49. 

- progress  of,  50. 

Mixtures,  administration  of,  179. 

Mixed  medical  practices,  62. 

Moisture,  application  of,  186. 

Molar  teeth,  110,  113. 

Monthly  nurse,  62. 

- nurses,  fees  of,  63. 

Moral  character,  formation  of,  161. 
Morning  sickness,  22. 

- treatment  of,  30. 

Mother  in  relation  to  infant,  86. 
Motherhood,  early,  76. 

Mothers’  marks,  162. 

Mouth,  affections  of,  211. 

Movement  of  child,  sensation  of,  2(i 
Mumps,  257. 

Musical  calisthenics,  158. 

Mustard  plasters,  187. 

- - poultices,  188. 

Myopia,  167. 

N 

N.evi,  162. 

Narcotic  drugs,  place  of,  43. 

Natural  food  of  infant,  135. 


INDEX. 


290 

Necessity  of  rest  in  miscarriage,  49. 
Nerve  stimulants,  153. 

Nettle-rash,  244. 

Night-caps,  130. 

Night-dresses  of  children,  130. 
Nightingale,  Florence,  172. 

Night  terrors,  219. 

Nipple,  depression  of,  87. 

- fissures  on,  89. 

- shield,  88. 

- tenderness  of,  89. 

Nitrogenous  food,  excess  of,  154. 
Non-viability,  56. 

Normal  development  of  child,  101. 

- frequency  of  pulse,  170. 

- frequency  of  respiration,  169. 

- progress  after  confinement,  82. 

- temperature  of  body,  171. 

Nose,  bleeding  from,  280. 

- foreign  bodies  in,  279. 

Nurse,  accommodation  of,  63. 

- duties  of,  168. 

- monthly,  62. 

Nursing  of  children  during  illness,  168. 

- duration  ^f,  98,  99. 

Nutrition  of  the  child,  135. 

O 

Oatmeal  poultices,  181. 

Objective  signs  of  pregnancy,  19. 
Observation  of  invalid,  168. 

- of  pulse,  170. 

- of  respiration,  169. 

Obstacles  to  suckling  infant,  85. 
Outdoor  exercise  for  children,  126. 

- exercise  for  wives,  16. 

P 

Painful  contractions  of  womb,  70. 

- digestion  in  infants,  92. 

Pain  in  miscarriage,  48. 

- in  stomach,  23. 

Pains,  false,  71. 

Parasitic  diseases,  263. 

Parotitis,  257. 

Peculiarity  of  children’s  digestive 
organs,  154. 

Peptonized  milk,  148. 

Perambulators,  126. 

Permanent  teeth,  113. 

Pertussis,  259. 

Physical  training  of  child,  156. 
Pigmentation  of  areola  of  breast,  24. 


Piles,  40. 

- external,  41. 

- internal,  41. 

- treatment  of,  42. 

Placenta,  description  of,  72. 

Plasters,  irritant.  187. 

- mustard,  187. 

Position  after  confinement,  81. 
Poultices,  181. 

- bran,  181. 

- bread,  182. 

- linseed,  181. 

- mustard,  188. 

- oatmeal,  181. 

- starch,  183. 

Powders,  administration  of,  179. 

- for  infants,  67,  68. 

Practices,  medical,  62. 

Precautions  before  confinement,  69. 
Pregnancy,  binder  in,  43. 

- diet  during,  30. 

- duration  of,  20. 

- external  signs  of,  19. 

- gastric  derangements  of,  22. 

- objective  signs  of,  19. 

- sleeplessness  in,  43. 

- symptoms  of,  19. 

Premature  confinement,  56. 

- causes  of,  56. 

- course  of,  57. 

Preparation  of  bed  for  confinement,  68. 
Preparations  for  confinement,  61. 
Preventive  treatment  of  miscarriage,  49. 
Probability  of  maternity,  12. 

Progress  of  miscarriage,  51. 

Prolapse  of  bowel,  238. 

Puberty  in  boys,  118. 

- in  girls,  115. 

Pulse,  how  to  feel,  170. 

- normal  frequency  of,  170. 

Q 

Quickening,  26. 

Quiet  after  confinement,  importance 
of,  77. 

R 

Recommencement  of  menstruation,  98. 
Red-gum,  125, 194. 

Requisites  for  infant,  67. 

- for  the  mother,  65. 

Respiration,  normal  frequency  of,  169. 

- observation  of,  169. 

Responsibilities  of  married  life,  11. 


INDEX. 


291 


Rest  and  effort,  Tb7. 

Rest,  importance  of,  159. 

Restlessness  at  night  during  dentition, 

212. 

Results  of  disuse  of  faculties,  156. 
Rheumatism,  266. 

- effects  of,  13,  267. 

- hereditary  tendency  to,  13. 

Rickets,  271. 

Riding  exercise,  16. 

Ringworm,  263. 

Rocking  cradles,  68. 

Roseola,  243. 

- epidemic,  256. 

Rose-rash,  243. 

Kotheln,  256. 

Rowing  exercise.  16. 

Rupture,  164. 

S 

Safety-pins,  67. 

Sagittal  suture,  103. 

Sand  in  urine,  201. 

Sanitary  towels,  66. 

Scabies,  264. 

Scalds,  276. 

Scarlatina,  252. 

Scarlet  fever,  252. 

Scrofula,  268. 

Scrofulous  glands,  269. 
Sea-bathing'during  pregnancy,  43. 
Second  dentition,  113. 

Second  stage  of  confinement,  73. 
Secondary  areola  of  breast,  25. 
Secretion  from  kidneys  of  infant,  105. 
Secretions  of  skin,  173. 

Select  medical  practices,  62. 

Selection  of  medical  attendant,  61. 
Sensations  of  movement  of  child,  27. 
Sense  of  fulness  of  stomach,  23. 

- of  weight,  relief  of,  36. 

Senses,  training  of,  160. 

Shivering  after  confinement,  76,  84. 
Shoes,  131. 

Short-sightedness,  167. 

“Show,”  71. 

Sickness  in  babies,  138. 

- morning,  22. 

Sick-room,  cleanliness  of,  172. 

- light  of,  176. 

- sunshine  in,  176. 

- temperature  of,  175. 

- ventilation  of,  173. 


Signs  of  indigestion  in  infants,  92. 

- of  pregnancy,  19. 

Sitting  up  after  confinement,  82. 

Size  of  infants,  102. 

Skin,  desquamation  of,  after  birth,  194. 

- of  infants,  124 

Sleep  required  by  infants,  108. 
Sleeplessness  in  pregnancy,  43. 
Small-pox,  252. 

Snoring,  228. 

Soaps,  67. 

Solid  animal  food,  152. 

Sources  of  heat,  175. 

Sourness  of  milk,  prevention  of,  140. 
Special  senses,  training  of,  160. 

Speech,  112. 

Spine,  curvature  of,  in  girls,  159. 
Sponges,  66. 

- artificial,  66. 

Spongio-piline,  188, 189. 

Sprains,  275. 

Squinting,  167. 

Stages  of  infectious  fevers,  249. 

Starch  poultices,  183. 

Sterilized  milk,  146. 

Stimulants,  effects  on  children,  153. 

- results  of  undue  indulgence  in,  17. 

Stockings,  elastic,  40. 

Stomach,  capacity  of  infant’s,  137. 

- cold  affecting,  232. 

- pain  in,  23. 

Stoups,  turpentine,  188. 

Stretching  of  skin  of  abdomen,  37. 

- - of  breasts,  37. 

Strophulus,  194. 

Stump  of  cord,  bleeding  from,  121. 
Subjective  symptoms  of  pregnancy,  19. 
Substitute  for  mother’s  milk,  136. 
Sucking,  difficulties  in,  136. 

- process  of,  87. 

Suckling,  duration  of,  96. 

- frequency  of,  90, 137. 

- obstacles  to,  85. 

Sunshine,  effects  of,  176. 

- in  sick-room,  176. 

Supernumerary  fingers,  164. 

- toes,  164. 

Susceptibility  to  infection  after  confine¬ 
ment,  84. 

Suspenders,  131. 

Sutures  of  infant’s  head,  102,  103. 
Sweeping  of  bedroom,  64. 

Swelling  of  feet  during  pregnancy,  38. 
- of  legs  during  pregnancy,  38. 


292 


INDEX. 


Swinging  as  an  exercise,  158. 
Symptoms  of  pregnancy,  19. 

Syringe  for  injection  of  glycerine,  35. 

- the  family  enema,  33. 

Syringing  after  miscarriage,  54. 

- of  ears,  189. 

T 

Tea,  in  diet  of  children,  153. 

Tears  or  wounds,  278. 

Teeth,  milk,  110. 

- permanent,  113. 

- wisdom,  115. 

Teething,  109. 

Temperature,  normal,  171. 

- of  artificial  food,  142. 

- of  invalid,  170. 

- of  sick-room,  175. 

Tenderness  of  nipple,  89. 
Thermometer,  clinical,  171. 

- for  sick-room,  175. 

Third  stage  of  confinement,  74. 
Thread-worms,  265. 

- affections  of,  223. 

- applications  to,  189. 

- catarrhal  inflammation  of,  224. 

Throat,  description  of,  223. 

Thrush,  195. 

- cause  of,  196. 

- treatment  of,  197. 

Tonsillitis,  subacute,  224. 

- treatment  of,  226. 

Tonsils,  enlargement  of,  228. 

Towels  for  infant,  67. 

Training,  mental,  160. 

- of  special  senses,  160. 

- physical  and  mental,  156. 

Tricycle  exercise,  16. 

Troifbles  of  infant  life,  192. 

- of  life,  minor,  192. 

Turpentine  stoups,  188. 


Umbilical  cord,  care  of,  121. 

- cord,  separation  of,  192. 

-  hernia, 165, 193. 

Urticaria,  244. 

Use  of  binder  in  sleeplessness,  43. 

y 

Vaccination,  205. 

Vaginal  discharge,  42. 

- irritation,  42. 

Value  of  companionship,  15. 

Varicella,  249. 

Varicose  veins,  39. 

Variola,  252. 

Veins,  distention  of,  39. 

Ventilation  of  sick-room,  173. 

Viability,  56. 

Vision,  imperfections  of,  166. 

Vomiting,  22. 

W 

Walking  exercise  for  wives,  16. 
Walking  powers  of  infant,  development 
of,  110. 

Washing  of  infant,  120. 

- of  invalid,  177. 

Waterbrash,  30. 

Waterproof  sheeting,  68. 

Weaning,  98,  99. 

Weights  of  children,  106. 

- of  infants,  101. 

Wet  nurse,  150. 

Whooping-cough,  259. 

Wisdom  teeth,  115. 

Womb,  contractions  of,  70. 

Worry  as  cause  of  miscarriage,  46. 
Wounds,  incised,  277. 

- lacerated,  278. 

Y 

Yellow-gum,  194,  195. 


V 


I 


i 


THE  HAGNET1C  CROUP  TIPPET. 

A  Valuable  Nursery  Article,  No.  47, 


of  il 

IN 


child 

ALL 


which,  when  tied  about  the  neck 
during  sleep,  is  WARRANTED 
CASES  TO  PREVENT  CROUP. 

Invented  by  Dr.  E.  B.  Foote  and  sold  by 
him  for  twenty  years.  It  has  proved  to  be  per¬ 
fectly  satisfactory  in  thousands  of  families,  and 
many  mothers  write  that  it  saves  fifty  dollars  in 
doctors’  bills  every  year.  Sent  by  mail  for  $2. 

A  pamphlet  on  CROUP,  with 

ADVICE  AND  PRESCRIPTIONS, 

FOR  TEN  CENTS. 


ABDOMINAL  SUPPORTERS,  No.  21 


are  of  great  comfort  to 
many  women  of  pendu¬ 
lous  abdomen,  and  es¬ 
pecially  to  those  who  feel  burdened  with 
pregnancy;  also  in  cases  of  “falling”  or 
anti-version.  Send  measure  about  thighs 
and  lower  abdomen.  Price,  $3  and  $5- 


FAMILY  SYRINGES. 


DR.  FOOTE’S.— The  ordinary  style,  with  rubber 
bulb  and  tubes,  and  rubber  pipes.  No.  22,  by  mail,  $i. 

THE  ARTERIAL-ACTION,  CONTINUOUS  FLOW, 
FAMILY  SYRINGE  is  a  first-class  article,  all  parts  of 
fine  rubber,  and  no  loss  of  valves  can  occur  ;  joints 
tight.  No.  23,  by  mail,  $2. 

FOUNTAIN  SYRINGES  are  the  lazy  man’s  (or  woman's)  friend;  no  bulb  to 

squeeze,  for  the  flow  of  water  is  made  strong  or  weak 
by  hanging  bag  high  or  low.  No.  25,  two-quart  size, 
$1.50;  No.  2G,  four-quart  size,  $2.50;  postage,  25c.  An 
extra  large  “irrigator”  pipe  (No.  27),  for  vaginal  cleans¬ 
ing,  costs  50c.  more. 

All  the  above  Family  (or  Fountain)  Syringes 
are  generally  useful  for  child  or  adult,  male  or  female, 
in  health  or  disease,  for  cleanliness  or  emergencies; 
but  we  call  the  attention  ot  married  women  to  an  ar¬ 
ticle  for  their  own,  exclusive  use,  viz. : 

DR.  FOOTE’S  SANITARY  SYRINGE,  for  thorough  cleansing  of  vagina,  and 
the  economical  use  of  medicinal  washes  without  waste  ;  also  for  hot  injections, 

when  heat  is  the  thing  prescribed,  a  little  hot  water  can  be 
made  as  effective  as  four  quarts.  It  works  by  injection 
and  suction,  and  without  mussing  or  “slopping  over.” 
Comes  in  three  sizes,  large,  small,  and  medium,  and  the 
latter  is  always  sent,  unless  others  are  specified.  No.  28,  price  $2,  by  express 
only  (as  the  cone  Is  of  glass).  We  can  also  furnish  the  Ladies’  Syringe,  all  soft 
rubber,  with  short  cone,  that  works  much  same  way,  for  $2.50,  by  mail  prepaid. 


Soluble  Sanitary  Tampons,  No.  IO. 

SeIf=Cure— Home  Treatment— For  Women, 

>rm  of  “  local  treatment  ”  or  “direct  medication  ”  adapted 
all  forms  of  u  Female  Weakness,”  Relaxation,  Prolapsus, 
ersions  and  Flections  ;  Chronic  Congestion  or  Inflamma- 
ion  of  Womb  or  Ovaries  ;  Ulceration  or  Granulation  of 
Neck  of  Womb  ;  Menstrual  Pains,  Irregularities,  etc. 

Leueorrhoea,  or  Whites. 

The  Soluble  Sanitary  Tampons  are  recommended  in  all  cases  where  there  are 
such  symptoms  as  loss  of  tone  or  feeling,  dragging  or  bearing  down  sensations, 
backaches,  pains  in  the  groins  or  distress  between  the  groins,  catarrhal  dis¬ 
charges,  profuse,  scant,  or  painful  periods.  In  short ,  they  are  offered  as  a  reliable 
substitute  for  the  old  methods  of  treatment  by  Caustics ,  Cutting ,  and  Pessaries ,  in 
a  great  variety  of  women’s  ailments  where  severe  measures  only  make  matters 
worse,  and  where  only  mild  measures  ought  to  be  used.  They  are  curative  in 
cases  of  Sterility  or  Apathy  due  to  any  of  the  diseased  conditions  named  above. 

$1  per  box,  mailed.  (No.  10  and  No.  0  work  well  together,  used  in  alternation.) 

Pelvic  Pine=Cones,  No.  O, 

are  “simply  wonderful”  in  their  cure  of  all  cases  of  Pelvic  Disorders,  attended 
with  heat,  soreness,  weakness,  irritation,  inflammation  of  the  rectum,  bladder, 
prostate  gland,  urethras,  seminal  vesicles,  womb,  ovaries,  etc.  In  cases  of  CON¬ 
STIPATION,  PROSTATORRHCEA,  SPERMATORRHEA,  LEUCORRHOEA,  PRURITUS,  CYSTI¬ 
TIS,  VESICULITIS,  OVARITIS,  PILES,  SPASM,  HEAT,  PAIN.  Dr.  Foote’s  Pelvic  Pine 
Cones  applied,  as  they  can  be  directly  to  the  seat  of  the  disease,  give  prompt  relief 
from  some  of  the  most  irritating  symptoms  that  worry  suffering  men  and  women. 
Trial  Convinces.  Price,  by  mail,  50c.  per  box. 

Skin  and  Toilet  Articles. 

No.  31.  Boracic  Acid,  to  improve  complexion,  relieve  itching,  and  minor  erup¬ 
tions,  red  spots,  scales,  and  dandruff  (a  fine  shampoo).  50c.  per  cake,  mailed. 

No.  32.  Ichthyol  Soap,  for  salt-rheum,  ring-worm,  unnatural  redness  of  nose 
or  face,  “skin  worms,”  black-heads,  pimples.  50c. 

No.  33.  Anti-Parasitic  Soap  banishes  all  superficial  parasites,  animal  or  vege¬ 
table;  fleas,  ring-worm,  itch  insects,  lice,  “crabs,”  and  is  useful  against  unclean 
eruptions  (syphilitic),  ulcers,  etc.  Great  for  itching  irritations.  50c. 

No.  34.  Sanitary  Caustic  will  gradually  eat  away  warts,  moles,  and  other  ex¬ 
crescences  without  exciting  inflammation  or  leaving  scars.  50c.  by  piail. 

No.  35.  Sanitary  Emulsion,  a  moth  and  freckle  lotion,  to  clear  the  complexion, 
which  it  does  by  erasing  the  color-patches,  brown  stains  and  deposits  left  by 
blood  impurities,  liver  torpor,  etc.  It  thoroughly  cleanses  the  pores,  dissolves 
hardened  secretions,  and  in  short  helps  “off  with  the  old  and  on  with  the  new” 
cuticle.  Mailed  for  50c. 

No.  36.  Depilatory,  removes  superfluous  hair  without  any  caustic  effect,  thus 
avoiding  the  injurious  effect,  of  the  ordinary  chemical  depilatories.  $1  per  box, 
by  mail. 

No.  1.  For  threatened  Baldness,  poor  growth  of  hair,  and  all  scalp  irritations, 
we  offer  our  regular  Magnetic  Ointment  (No.  1)  as  the  best  remedy,  and  can  show 
the  finest  testimonials  to  its  usefulness  in  this  line.  25c.,  50c.,  and  $1. 

No.  37.  Sanitary  Powder-just  the  thing  for  sore  feet,  moist,  itchy  skin  surfaces, 
chafing,  etc.  Handy  for  ladies’  and  babies'  toilets;  also  for  barbers,  big  and  little 
shavers.  Relieves  tender  feet,  moist  arm-pits,  and  many  forms  of  skin  disease 
needing  a  drying,  disinfectant,  soothing  and  real  sanitary  influence.  Dispels  Dis¬ 
agreeable  Odors  of  the  body;  substitutes  better  odor.  Price,  25c.  per  box. 


THE  MAGNETIC  OINTMENT. 

It  is  a  positive  cure  for  all  sprains,  bruises,  burns,  flesh  wounds,  sore  throat, 
stiff  neck,  backache,  broken  breast,  sore  nipples,  colic  pains,  cramps,  earache, 
pains  in  all  parts  of  the  system;  and  greatly  assuages  the  pains  of  hard  and  soft 
corns,  boils,  felons,  carbuncles,  rheumatism,  neuralgia,  etc. 

It  is  a  reliable  medicine  for  children,  who  should  not  be  dosed  with  drugrs.  This 
external  medicine  will  answer  in  nearly  every  emergency  in  removing  the  ills  com¬ 
mon  to  infants.  Applied  to  the  stomach  it  relieves  wind  colic,  loss  of  appetite, 
sour  stomach,  etc.  Applied  to  the  bowels  it  softens  excrementitious  matter,  re¬ 
lieving  constipation.  It  also  cures  diarrhoea,  by  relieving  the  intestinal  irritation 
which  causes  it,  if  applied  to  the  bowels.  It  is  a  valuable  remedy  for  the  nursery. 
Every  young  mother  should  have  it. 

It  greatly  promotes  easy  labor  and  should  be  conveniently  at  hand.  Invalua¬ 
ble  to  every  woman,  especially  just  before,  during,  and  after  confinement,  for  the 
relief  of  piles,  cramps,  abdominal  muscular  pains,  excessive  after-pains,  sore  nip¬ 
ples,  broken  breasts,  etc.,  etc. 

Price,  by  mail,  prepaid,  in  4-oz.  can,  $1.00;  also  25  and  50  cent  sizes. 

WHAT  ITS  FRIENDS  SAY  OF  IT. 

FROM  THOSE  WHO  HAVE  TRIED  IT  AND  ORDER  MORE. 

For  Everything.— “We  cannot  get  along  without  your  Magnetic  Ointment,  for  it 
is  the  best  medicine  for  everything  that  we  ever  used.  One  of  our  neighbors  had 
sore  breasts  and  my  wife  sent  her  some  of  it,  which  cured  her  in  two  days.” 

For  Rheumatism.— The  Rev.  Wm.  Scott  Downey,  of  New  York,  says:  “I  write 
from  my  sick  chamber  to  say  your  Magnetic  Ointment  is  one  of  the  best  remedies 
for  rheumatism,  cuts,  piles,  carbuncles  and  corns  that  can  be  used.  The  more 
I  use  the  Ointment  the  more  I  am  astonished  at  its  efficacy.  For  the  good  of  our 
neighbors  I  advise  you  to  set  its  value  before  the  public.  Were  I  young  and  in 
health  I  am  quite  certain  I  could  make  a  living  from  being  your  agent,  selling  that 
Ointment  particularly.'1'1 

For  Piles.— A  lady  patient  writes:  “  I  gave  some  of  your  Magnetic  Ointment  to 
a  lady  who  was  suffering  with  piles  and  it  helped  her  so  much  that  she  desired  me 
to  sell  her  a  bottle  of  mine,  which  I  did.  She  said  she  wanted  more.”  A  physician 
also  writes :  “  I  have  found  it  to  effect  speedy  relief  in  piles.” 

For  Confinement.— A  lady  writes:  “I  was  confined  July  2d,  and  had  a  very 
quick  and  easy  time.  I  think  your  Ointment  the  best  thing  ever  tried  in  confine¬ 
ment.” 


MAGNETIC  ANTI  =  BILIOUS  PILLS. 

These  Pills  are  an  entirely  vegetable  substitute  for  mercury,  and  their  action 
upon  the  liver  is  far  superior  to  that  of  any  drug.  They  are  each  electrically  neg¬ 
ative,  and  when  taken  into  the  stomach  they  awaken  the  positive  forces  of  the 
gastric  juice  to  healthy  action  and  attract  the  same  forces  of  elimination  to  act 
upon  the  functions  of  the  liver,  causing  a  free  discharge  of  bile  into  the  intestinal 
canal,  where  its  dissolving  and  lubricating  properties  soften  the  excrementitious 
matters  and  give  them  an  easy  and  natural  passage  through  the  small  intestines 
and  lower  bowel,  while  the  properties  of  the  medicine  continue  to  act  as  a  tonic 
upon  all  these  enfeebled  or  inactive  organs  and  canals.  They  infallibly  cure  bil¬ 
ious  headache,  ordinary  or  chronic  constipation,  want  of  tone  of  the  stomach  or 
bowels,  promote  digestion,  cause  healthy  assimilation  of  nutriment,  and,  in  fact, 
are  the  best  family  pill  in  use. 

Price,  single  box,  by  mail,  35  cents;  large  box,  $1. 

WHAT  PEOPLE  SAY  OF  THESE  PILLS. 

The  following  are  quotations  from  bona-fide  letters  on  file  in  Dr.  Foote’s 
office,  but  the  names  are.  omitted,  as  they  are  extracts  from  confidential  letters: 

“  Your  Anti-Bilious  Pills  are  the  best  I  have  ever  taken,  and  I  would  not  be 
without  them  for  ten  times  what  they  cost;  in  fact,  I  think  they  have  done  more 
for  me  than  any  other  medicine.” 

“  Please  forward  another  dozen  boxes  of  your  Pills.  They  are  the  best  I  have 
e.ver  used,  and  I  have  tried  several  kinds.” 

Address, 

DR.  FOOTE’S  SANITARY  BUREAU, 

129  East  28th  Street,  NEW  YORK. 


A  FEW  LAST  REMARKS 
ON 

MEDICAL  SPECIALISTS— THEIR  FUNCTIONS  AND  METHODS. 


The  following  excerpt  from  the  Philadelphia  Polyclinic  is  given  as 
evidence  of  growing  rationalism  in  old-school  circles  on  the  subject  of 
specialism  in  modern  medical  practice.  The  necessity  of  some  means 
of  advertising  as  an  accompaniment  of  its  development  is  acknowl¬ 
edged,  and  the  propriety  of  direct  or  straightforward  methods,  in  place 
of  prevalent  roundabout  ways,  is  pretty  distinctly  intimated.  Maybe 
some  day  we  will  awake  to  find  that  in  this,  as  well  as  other  progres¬ 
sive  ideas,  we  have  been  simply  leading  the  procession  and  setting  the 
style,  when  some  thought  we  were  pursuing  an  erratic  or  irregular 
course  : 

“The  increase  of  specialism  can  only  go  on  as  the  specialist  is  able 
to  draw  on  a  larger  number  of  people  for  his  support,  and  to  do  this  he 
must  in  some  wTay  acquaint  that  larger  number  with  himself  and  his 
work.  Extending  this  acquaintance  is  the  legitimate  function  of 
advertising.  Specialism  and  advertising  of  some  sort  necessarily  go 
together.  This  connection  is  neither  recent  nor  local,  nor  temporary. 
When  the  doctor  gave  up  his  farming  or  storekeeping,  he  put  out  a 
sign  and  got  a  degree,  setting  forth  what  sort  of  work  he  expected  to 
do,  and  assumed  a  professional  demeanor,  all  calculated  to  extend  in 
the  community  the  knowledge  of  what  service  he  was  prepared  to 
render.  And  with  large  numbers  of  people  to  be  reached,  and  new 
means  at  hand  by  which  to  inform  them  of  his  existence,  no  ‘conserva¬ 
tism  ’  on  the  part  of  those  who  fail  to  recognize  the  continuous  forward 
flow  of  events  will  prevent  the  adoption  of  new  methods  of  advertising. 

“By  the  later  specialists,  teaching  and  hospital  positions  have  been 
eagerly  sought  for  their  supposed  advertising  value,  and  the  article  in 
the  medical  journal  has  become  a  part  of  the  routine  task  of  the  aspir¬ 
ant  in  this  direction,  until  the  profession  and  the  community  are  both 
suffering  from  the  multiplicity  of  medical  schools  and  hospitals,  and 
legitimate  medical  literature  is  drowned  in  the  torrent  of  medical  writ¬ 
ing.  And  still  the  professors  and  holders  of  official  positions  are  cer¬ 
tifying  nostrums  and  ‘mineral  waters,’  being  interviewed  by  the 
ubiquitous  reporter,  and  in  every  way  struggling  to  have  their  names 
floated  to  a  still  larger  circle  of  possible  patients. 

“There  can  be  no  question  but  that  specialization,  in  so  far  as  it  is 
normal,  is  progress  ;  that  the  community  is  better  served ,  more  cheaply 
and  satisfactorily  served ,  by  legitimate  specialists  than  by  jacks-of -all- 
trades.  Specialism  is  bound  to  extend,  and  for  the  evils  its  attempts  at 
advertising  now  inflict,  no  more  legitimate  remedy  will  be  found  than 
proper  and  efficient  means  of  accomplishing  this  necessary  function, 

1224 


MEDICAL  SPECIALISTS. 


1225 


When  Dr.  Smith  can  otherwise  let  the  community  know  that  he  is  pre 
pared  and  desires  to  practise  ophthalmic  surgery,  his  desire  for  a  pro 
fessorsliip  or  a  hospital  service,  irrespective  of  his  aptitude  for  teaching 
or  his  interest  in  studying  hospital  cases,  will  be  greatly  moderated  ; 
the  true  teacher  and  clinical  student  will  have  a  correspondingly  better 
chance,  and  mushroom  medical  schools  and  new  hospitals  will  be  less 
of  a  burden  in  the  land.” 

The  specialist  is  confronted  with  another  prejudice  existing  to 
some  extent  in  the  public  mind  and  which  is  professedly,  though  we 
think  not  sincerely,  entertained  by  the  average  physician.  It  is  that  a 
specialist  living,  say  in  the  city  of  Newr  York,  cannot  successfully 
attend  to  some  case  of.  chronic  disease  in  Chicago,  San  Francisco,  or 
Australia.  It  will  be  conceded  instantly  that  in  all  cases  of  acute  dis¬ 
ease  a  physician  must  be  close  at  hand.  In  five  minutes’  time  the 
symptoms  may  change  in  such  a  way  as  to  require  immediate  attention. 
But  this  is  not  true  of  chronic  diseases.  There  are  many  having 
chronic  diseases  who  will  even  assume  to  treat  themselves  by  resorting 
to  some  domestic  remedies,  or  by  going  to  the  drug-store  and  purchas¬ 
ing  some  proprietary  nostrum.  With  no  knowledge  of  medicine  what¬ 
ever,  they  guess  at  the  nature  of  the  complications  affecting  them,  and 
then  guess  again  as  to  the  remedy  which  would  probably  be  the  best 
suited  to  their  complaints.  It  need  not  be  said  that  this  is  tampering 
with  one’s  self.  A  person  is  quite  at  liberty  to  pursue  this  haphazard 
course  if  he  chooses  to  do  so,  but  it  is  perfectly  proper  to  pronounce 
such  a  course  quite  imprudent,  to  say  the  least  manifestly  indiscreet. 
But  when  such  a  person  avails  himself  of  the  wonderful  facilities  of 
our  civilization,  the  quick  mails  and  express,  it  is  clearly  the  very 
thing  to  do,  for  a  person  having  some  disease  which  has  resisted  home 
skill  to  apply  to  a  noted  specialist  who  has  mainly  acquired  his  celeb¬ 
rity  and  good  reputation  through  his  medical  success.  With  a  practice 
reaching  out  from  his  office  to  all  the  States  and  Territories,  he  can 
hardly  fail  to  acquire  an  experience  which  will  enable  him  to  perform 
what  many  will  regard  as  miracles.  A  person  having  a  chronic  disease 
of  a  difficult  character  is  infinitely  better  off  in  the  hands  of  a  noted 
specialist  one  hundred  or  one  thousand  miles  away,  than  he  can  be 
under  the  supervision  of  one  whose  time  and  professional  skill  is  mostly 
employed  in  the  treatment  of  a  class  of  ills  as  little  like  those  of  a 
chronic  character  as  a  mule  is  like  a  horse  or  a  goat  is  like  a  jackass. 
We  therefore  say  that  an  invalid  who  has  been  suffering  for  months 
and  perhaps  for  years  with  a  supposed  incurable  malady  is  fully  justi¬ 
fied,  in  the  light  of  reason  and  common  sense,  in  opening  communica¬ 
tion  with  one  having  a  wide  range  of  experience  in  the  treatment  of 
such  ills. 


E.  B.  FOOTE,  M.D. 


1  226 


ADVERTISEMENTS. 


Dr.  E.  B.  FOOTE  and  His  Assistants 

May  be  Consulted  daily,  from  9  a.  m.  to  6  p.  m. 

(excepting  Sundays), 

In  the  English  or  German  Languages, 
at  their  office, 

120  LEXINGTON  AVENUE,  Cor.  of  EAST  28th  STREET, 

NEW  YORK  CITY. 


For  convenience  and  permanence  of  location,  Dr.  Foote  purchased,  in  1867, 
the  property  above  mentioned,  and  here  his  professional  work  has  been  carried 
on  for  over  thirty  years.  It  is  within  one  short  block  of  the  Third  or  Fourth  Avenue 
surface  railroads,  and  a  station  of  the  Third  Avenue  elevated  road.  The  Lexing¬ 
ton  Avenue  trolley-cars  run  by  the  door— a  branch  of  the  Broadway  route.  It  is  not 
far  from  the  Grand  Central  Depot,  at  Forty-Second  Street  and  Fourth  Avenue,  and 
by  the  above  named  car-lines  and  transfers  it  is  easily  reached  from  the  routes  of 
travel  which  land  rheir  passengers  in  New  York  by  ferry.  Dr.  Foote’s  office  is  but 
a  few  steps  from  Madison  Square  Garden. 

In  answer  to  numerous  inquiries,  Dr.  Foote  takes  this  opportunity  to  in¬ 
form  coi'respondents  that  he  cannot  accommodate  patients  with  board.  There 
are,  however,  hotels  and  boarding-houses  within  a  convenient  distance,  fashion¬ 
able  and  expensive,  and  unfashionable  and  comparatively  cheap,  where  invalids 
can  obtain  accommodations  according  to  their  means. 


IN  THE  TREATMENT  OF  CHRONIC  DISEASES, 

Dr.  Foote  makes  use  of  all  the  remedial  agencies  recommended  in  this  work. 
Each  disease  is  attended  according  to  its  individual  peculiarities,  and  such  treat¬ 
ment  prescribed  as,  in  all  human  probabilities,  will  most  likely  insure  success. 

Invalids  preferring  to  consult  by  letter  are  referred  to  page  761,  where  a  list  of 
questions  will  be  found,  answers  to  which  will  enable  the  author,  by  a  careful 
analysis  of  symptoms,  to  form  a  correct  opinion  of  the  nature  and  curability  of  the 
oase. 

ALL  CONSULTATIONS, 

In  person  or  by  letter,  in  the  English  or  German  languages,  are  free,  with 
the  exception  of  those  relating  to  matters  referred  to  on  pages  1080  and  HOT.  All 
consultations,  either  personally  or  by  letter,  are  strictly  confidential.  This  rule 
has  been  so  faithfully  observed  by  the  author  in  his  long  and  extensive  practice, 
that  no  person  who  has  ever  consulted  him  can  complain  of  its  infraction  in  a 
single  instance. 

All  letters  are  promptly  answered  when  there  is  any  reply  called  for.  This  is 
an  invariable  rule;  consequently  anyone  who  addresses  the  author  without 
receiving  within  reasonable  time  an  acknowledgment,  may  rest  assured  that 
either  the  letter  of  the  correspondent  or  the  reply  thereto  has  miscarried. 

RESIDENTS  OF  FOREIGN  COUNTRIES, 

England,  France,  Germany,  and  even  Japan,  China,  Australia  and  South  Africa, 
where  this  book  has  already  found  a  wide  circulation  and  made  hundreds  of 
friends,  have  availed  themselves  of  the  offer  of  free  consultation  by  mail ,  and 
others  are  hereby  invited  to  consider  themselves  welcome  to  seek  advice  in  the 
same  manner.  There  are  many  forms  of  chronic  disease  which  can  be  successfully 
treated  afar  off,  as  abundant  letters  of  evidence  iu  hand  attest. 


ADVERTISEMENTS.  1227 


SANITARY  ARTICLES,  INSTRUMENTS,  MEDICINES,  Etc. 

SUPPLIED  BY  MAIL  OR  EXPRESS  FROM 

Dr.  Foote’s  “Sanitary  Bureau,”  129  E.  28th  St.,  N.  Y. 

[Make  money  orders,  etc.,  payable  to  Dr.  H.  T.  Foote,  Manager.] 

( A  more  complete  descriptive  list  or  catalogue  sent  free.) 


EYE-SHARPENER,  or  Self  Sight  Restorer,  for  the  restoration  of  sight  impaired 
by  age.  LSee  page  734.]  Sent  by  mail,  postage  paid,  on  receipt  of  $2.  Agents 
wanted. 


U1AGNETIC  CROUP  TIPPET. — Warranted  to  prevent  croup.  A  valuable,  sim- 
VI  pie,  and  perfectly  comfortable  nursery  article,  which  has  stood  the  test  of 
orty  years’  trial,  given  perfect  satisfaction  and  insured  welcome  relief  in  thou¬ 
sands  of  families.  Sent  by  mail  for  $2.  (A  pamphlet  of  advice  and  prescriptions 
for  10  cts.) _ _ 

FAMILY  SYRINGES. —a  plain,  compression  bulb,  Family  Syringe,  with  three 
rubber  pipes,  by  mail  for  $1. 

“THE  ARTERIAL  ACTION,  Continuous  Flow,  all  rubber  Syringe  (pipes  of  hard 
I  rubber) ;  a  first-class  article,  for  $2.00,  by  mail. 

FOUNTAIN  SYRINGES,  with  three  hard  rubber  pipes,  two-quart  size  for  $1.50, 
I  and  four-quart  size  for  $2.50;  postage  25  cents  extra. 

SANITARY  SYRINGES,  for  married  women ,  only,  are  great  for  thorough  cleans¬ 
ing and  use  of  medicinal  washes  without  waste;  by  express  only,  for  $2.00. 

ELECTRO-THERAPEUTIC  MACHINES— the  best  medical  batteries;  less  expen¬ 
sive  and  better  than  “magnetic”  or  “electric”  belts,  bands,  medals,  gar¬ 
ments,  etc.,  most  of  which  are  useless  clap-trap.  Elegant,  practical,  and  handy 
machines;  $8,  $12. 


HICK’S  PATENT  AIR-INFLATED  RUBBER  TRUSS  PADS.— One  cure  pad  and 
one  relief  pad— can  be  adjusted  to  any  truss.  Price  $3.00  each,  or  the  pair  for 
$5,  by  mail,  prepaid.  The  “cure”  is  as  sure  cure  as  any  “appliance”  offered  at 
ten  times  the  cost,  and  the  “relief  ”  pad  is  the  most  comfortable  one  that  can  be 
worn  in  any  case. _ 

TRUSSES,  SINGLE  AND  DOUBLE.— Single  truss,  fitted  with  two  of  Hick’s  pads, 
I  $12;  double  truss,  fitted  with  four  pads,  $15.  When  ordering  any  truss  send 
measurement  in  inches  around  the  body  at  the  level  of  the  hips.  These  Are  fine 
goods,  well  finished,  neatly  covered  and  durable. 


PHIMOSIS  INSTRUMENT.— For  the  cure  of  congenital  or  acquired  Phimosis 
[contracted  foreskin]  without  circumcision,  cutting,  tearing,  or  pain.  An 
instrument  which  can  be  safely  put  in  the  hands  of  the  patient  himself  to  effect 
his  own  cure,  and  one  which  cannot  fail  when  intelligently  applied  according  to 
directions.  Price,  by  express,  $10. _ 

SPERMATORRHOEA  RING. — An  easily  adjusted  instrument  to  give  the  sleeper 
timely  warning  in  case  of  threatened  involuntary  loss.  By  mall,  prepaid,  $1.50. 

SCROTAL  SUPPORTERS  FOR  GENTLEMEN.— A  comfortable  suspensory  for 
relaxed  parts;  absolutely  indispensable  in  VARICOCELE,  invaluable  in  all 
cases  of  swelling  or  disease  of  the  testicles,  and  always  an  aid  in  the  cure  of  Sper¬ 
matorrhoea.  Simple  suspensory  for  support,  75 cents,  by  mail,  prepaid.  One-string 
compression  supporter,  the  improved  supporter.  $1.50.  Three-string  bandage,  for 
bad  cases  of  varicocele,  hydrocele,  and  orchitis  [inflamed  testicle],  $3.  Each 
style  made  in  three  sizes  ;  small,  medium,  and  large.  [Read  Chapter  VIII.  (Dis¬ 
eases  of  Men)  of  this  book.]  _ _ 

PILE  COMPRESSOR.— For  external  [protruding]  piles  and  falling  of  the  rectum; 

a  source  of  great  comfort  to  many  sufferers.  [See  page  449.]  By  mail, 
reduced  from  $10  to  $5.  In  ordering  send  waist  measure  to  insure  right  size. 

SHOULDER  BRACES  AND  ABDOMINAL  SUPPORTERS.— For  both  sexes. 

When  ordering  a«shoulder-brace  send  measurement  around  chest,  under  arms, 
and  around  waist;  also  from  sdoulder  blade  to  waist.  Price,  by  mail,  prepaid. 
$2;  steel  back  brace,  to  order,  $5.  When  ordering  abdominal  supporter  send 
waist  measurement,  and  also  largest  abdominal  girth.  Price,  $5  by  mail. _ 

IMPREGNATING  SYRINGE.— An  instrument  for  facilitating  conception  in  cases 
I  of  barrenness  due  to  obstruction  in  the  neck  of  the  womb.  Price,  with  full 
directions,  $5  by  mail. 


1228 


ADVERTISEMENTS. 


Dr.  Foote’s  Standard  Specialties 

Supplied  by  mail  or  express  from 
Dr.  Foote’s  Sanitary  Bureau*  129  East  28th  St.,  New  York. 

(A  More  Complete  Illustrated  Circular  sent  free.) 


No.  0,  Pelvic  Pine  Cones, 


Direct  local  treatment  for  piles  and  constipation. 

A  “  wonderful  relief”  in  all  rectal  diseases,  anal  fissure,  etc. 

Also  for  prostatic,  bladder,  and  deep  urethral  irritations. 

Works  well  with  No.  10 in  all  “female  complaints.” 
Price  by  mail,  50  cents  per  box;  twelve  boxes  for  $5.00. 


No.  1.  Magnetic  Ointment, 


Cures  sprains,  bruises,  wounds,  sore  throat,  stiff  neck, 

Backache,  sore  nipples,  colic,  cramps,  piles,  corns, 

Relieves  rheumatism,  salt  rheum,  boils,  felons, 

Promotes  easy  labor.  A  boon  to  mothers. 

A  valuable  remedy  for  all  infants’  ills. 

Price  by  mail,  sample,  25  cts. ;  2  ozs.,  50  cts. ;  4  ozs.,  $1.  By  .express  only,  at 
purchaser’s  expense,  16  ozs.,  $3. 

No.  2,  Magnetic  Catarrh  Balm, 

Cures  nasal  catarrh,  sore  eyes  and  ears,  chapped  lips. 

Disinfects  discharges,  softens  scabs,  allays  itching, 

Soothes  irritable,  inflamed  mucous  membranes. 

Price,  50  cts.  per  jar,  by  mail. 

No.  3.  Magnetic  Anti-Bilious  Tablets,  EntirelyvNotmeIrcury. 

Cure  biliousness,  sick  headaches,  chronic  constipation, 

Liver  torpor,  sallowness,  nausea,  hemorrhoids,  flatulence. 

Promote  digestion,  assimilation,  pure  blood. 

Stimulate  elimination,  cleanse  entire  system. 

Price  25  cts.  by  mail;  large  box,  $1. 

No,  4.  Tonic  and  Ague  Tablets,  Sanitary  aromatto,  bittcrbarks; 

Cure  chills  and  fever,  dumb  ague,  all  malaria. 

Loss  of  appetite,  bloodlessness,  weakness,  blues. 

Price  by  mail,  50  cts.  per  box  of  90  tablets— 90  doses. 

No.  8.  Anti-Rheumatic  Tablets,  A  FINE  KIDNEY  TONIC. 

Cure  rheumatism,  gout,  sciatica,  lumbago  and  all 

Headaches,  heart,  lung  and  skin  diseases  caused  by 

uric  acid  in  the  blood;  and  Bright’s  disease. 

Price  by  mail,  50  cts.  per  box  of  60  tablets. 

No.  10.  Soluble  Sanitary  Tampons,  stren?Sepfichealing’ 

Self-cure,  home  treatment  for  diseases  of  women. 

“  Direct  medication  ”  for  misplacements,  inflammation. 

Menstrual  pains  and  irregularities,  apathy,  sterility, 

Leucorrhoea,  ulceration— a  mild  medicament. 

One  box  of  tampons  sufficient  for  one  month,  by  mail,  $1.  Six  boxes,  $5.00. 

No.  11.  Magnetic  Cramp  Tablets,  a  soothing  pain-kmer 

Cure  colic,  dyspeptic  headaches,  pains  and  cramps, 

"Bowel  complaints,”  scant  and  painful  “periods.” 

A  great  boon  to  women  and  children. 

Price  by  mail,  50  cts.  per  box  of  90  tablets. 

No.  12,  Magnetic  Cough  Tablets,  A  safe  anodyne 

Cure  spasmodic  coughs  and  nervous  headaches. 

Neuralgia,  nervous  irritability,  hysteria,  and  sleeplessness. 

Price  by  mail,  50  cts.  per  box  of  90  tablets. 


WITHOUT  OPIATE. 


WITHOUT  OPIATE. 


ADVERTISEMENTS. 


1229 


100  Pointers  for  Self=Treatment. 


Abscesses,  boils;  Nos.  1,  3,  4,  8. 

Acidity  of  stomach;  Nos.  3, 11. 

Acne  (pimples);  Nos.  1,  2,  3,  4. 

Ague;  Nos.  3,  4,  8. 

Amenorrhcea  (suppressed  or  scanty  pe¬ 
riods)  ;  Nos.  4, 10, 11. 

Asthma;  Nos.  1,  4,  8,  12. 

Bad  breath;  Nos.  3,  4,  8. 

Baldness,  dandruff;  No.  1,  pomade. 
Biliary  colics;  Nos.  3,  4,  8, 11. 
Biliousness  (sallow  skin,  yellow  tongue, 
constipation) ;  Nos.  3,  4. 

Bites  of  insects;  Nos.  1,  2. 

Blood  disorders;  Nos.  3,  4,  8. 

Breasts  inflamed ;  No.  1. 

Bright’s  disease  (kidney);  Nos.  4,  8. 
Bronchitis;  Nos.  1  (to  chest),  12. 

Bruises,  burns,  etc.;  No.  1. 

Catarrh,  nose,  eyes,  ears;  Nos.  2,  3,  4. 
Chapping,  chilblains,  etc.;  Nos.  1,  2. 
Cholera  infantum;  Nos.  1,11. 

Chorea  (St.  Yitus's  Dance);  Nos.  4,  12. 
Colds,  coryzas;  Nos.  2,  3,  4,  8. 
Confinement,  to  ease  labor;  No.  1. 
Constipation;  Nos.  1,  3,  4,  0. 
Consumption  (lungs);  Nos.  1,  4,  12. 
Convulsions;  Nos.  1,  3,  12.  Hot  baths. 
Coughs;  Nos.  1  (to  throat),  12. 

Cramps;  Nos.  1  (to  bowels),  11. 

Cystitis  (inflamed  bladder);  Nos.  0,  1,  8, 
and  slippery-elm  tea. 

Dengue,  a  malarial  fever;  Nos.  3,  4. 
Diarrhoea  in  infants;  Nos.  1,  11. 
Dizziness  (dyspeptic);  Nos.  11,  3,  4. 
Dropsy;  Nos.  3,  8. 

Dysentery;  Nos.  1,  3,  11. 

Dysmenorrhoea  (painful  periods);  Nos. 

0,  1,  10,  11. 

Dyspepsia;  Nos.  3,  4, 11. 

Eczema  (saltrheum);  Nos.  1,  2,  3,  4,  8. 
Epilepsy;  Nos.  4,  8,  11,  12. 

Eyelid  inflammations;  Nos.  1,  2. 

Far  sight,  “  old  eyes;”  No.  48. 

Fevers;  Nos.  4, 12. 

Fissure  of  lip  or  anus;  Nos.  1,  2,  3. 
Flatulence;  Nos.  3,  4, 11. 

Gastralgia,  gripes;  Nos.  1,  11,  12. 

Glands,  enlarged;  Nos.  1,  3,  4. 
Gonorrhoea;  Nos.  1,  3,  4,  8. 

Gout;  Nos.  1,  3,  4,  8. 

Gravel,  uric  acid;  Nos.  3,  4,  8. 

Hay  fever;  Nos.  2,  4, 12. 

Heartburn,  water  brash;  Nq,  11, 


Headaches;  periodical,  liver  and  sto¬ 
mach,  over  eyes;  Nos.  3,  4,  11.  In 
rheumatic,  gouty  persons  in  back, 
head,  or  neuralgic;  Nos.  3,  4,  8,  12. 
Malarial,  periodic ;  Nos.  3,  4.  Nervous 
exhaustion;  Nos.  4, 12.  At  menstrual 
periods ;  Nos.  11,  12.  On  top  of 
head;  womb  disease;  Nos.  4,  10,  11. 
Hiccough;  Nos.  11,  12. 

Hoarseness;  Nos.  1, 12. 

Hysteria;  Nos.  4,  12. 

Incontinence  of  urine;  No.  12. 

Itching;  Nos.  1,  2,  4,  8,  31,  or  33. 
Jaundice;  Nos.  3,  4. 

Kidney  diseases;  Nos.  1,  4,  8. 

Kidney  colic;  Nos.  8,  11,  12. 

Leucorrhcea  (whites);  Nos.  4,  10,  0. 

Lice;  Nos.  1,  33. 

Liver  torpor;  Nos.  1,  3,  4. 

Lumbago;  Nos.  1,  3,  8. 

Malaria,  chills,  fever;  Nos.  3,  4. 

Nervous  exhaustion;  No.  4. 

Nervous  irritability;  Nos.  4,  12. 
Night-sweats;  Nos.  1,  3,  4,  12. 

Nipples,  sore,  cracked;  Nos.  1,  2. 

Pains,  aches,  soreness;  No.  1. 

Piles  (hemorrhoids);  Nos.  0,  1,  2,  3,  15. 
Pleurisy,  pneumonia;  Nos.  1,  4,  12. 
Prolapsus  of  rectum;  No.  1,  and  a  salve 
of  tannin,  alternating. 

Prolapsus  (falling  womb);  Nos.  4,  10. 
liingworm;  Nos.  1,  32,  37. 

Sciatica;  Nos.  1,  3,  4,  8,  12. 

Seat  worms;  No.  1,  at  night,  and  salt 
water  injections  mornings. 

Skin  (scaly)  diseases;  Nos.  1,  3,  4,  8. 
Sleeplessness;  Nos.  11,  12. 

Sore  nipples,  throat,  sprains;  No.  1. 

Stiff  neck,  stiff,  lame  back;  No.  1. 
Stomach  ache;  Nos.  1, 11. 

Sunburn,  freckles,  blotches;  No.  1. 
Sweating  feet;  Nos.  31,  37. 

Tonsillitis;  Nos.  1,  to  throat;  12. 

Ulcers;  dress  with  No.  1,  and  wash  with 
suds  of  No.  33. 

Varicocele;  Nos.  16,  17,  18. 

Vertigo,  dizziness;  Nos.  3,  4,  II. 
Vomiting;  No.  11.  No.  1  to  stomach. 
White  swelling;  No.  1,  and  tight  ban¬ 
daging. 

Whooping  cough;  No.  12,  and  tea  of 
red  clover  blossoms. 

Wounds;  No.  1,  plastered  on  lint. 


1230 


ADVERTISEMENTS. 


FACIAL  BLEMISHES. 

Besides  the  disfigurements  caused  by  various  skin  diseases,  already  sufficiently 
described  in  Chapter  X.  there  are  several  minor  ones,  hardly  belonging  among 
diseases,  and  yet  a  source  of  much  annoyance.  Some  are  birth-marks,  nccvi, 
which  can  only  be  removed  by  operation.  Some  are  scars,  from  accidents,  which 
can  seldom  be  removed.  Some  are  like  freckles ,  peculiar  to  the  skin,  and  hardly 
removable.  But  many  blemishes  are  mere  superficial  growths,  warts  or  moles, 
that  can  be  readily  and  safely  eaten  off  by  mild  caustics  persistently  applied. 
“  hirer  spots  ”  and  other  local  stains,  can  be  removed  by  lotions  that  bleach  the 
skin  without  harm;  but  these  and  more  general  stains  that  constitute  a  “bad 
complexion  ”  are  often  indications  that  there  is  need  of  general  treatment  to 
purify  the  blood  and  secretions. 

Hair  may  grow  where  it  ought  not  to— “superfluous  ’’—and  may  fall  out  where 
it  is  wanted— baldness.  These  complaints  are  often  dependent  upon  general  faults 
of  nutrition,  deserving  of  attention,  and  yet  the  immediate  and  most  practical 
treatment  for  many  cases  is  local.  Recognizing  the  desire  for  self-improvement  in 
this  direction  as  commendable.  Dr.  Foote  has  sought  the  safest  and  most  legiti¬ 
mate  methods  of  relief  for  these  personal  defects,  and  offers  the  following  list  of 

Safe  Sanitary  Skin  and  Toilet  Articles. 

No.  31.  Boracic  Soap, 

To  improve  complexion,  relieve  itching,  and  minor  eruptions,  red  spots,  scales 
and  dandruff  (a  fine  shampoo),  50  cents  per  cake,  mailed.  For  every-day  use. 

No.  32.  Ichthyol  Soap. 

For  saltrheum,  ringworm,  un  atural  redness  of  nose  or  face,  “skin  worms,” 
blackheads,  pimples.  50  cents,  by  mail. 

No.  33.  Anti-Parasitic  Soap, 

Banishes  all  superficial  parasites,  animal  and  vegetable;  fleas,  ringworm,  itch 
insects,  lice,  “crabs,”  and  is  useful  against  unclean  eruptions  (syphilitic),  ulcers, 
etc.  50  cents,  by  mail. 

No.  34.  Sanitary  Caustic, 

Will  gradually  eat  away  warts,  moles,  and  other  excrescences  without  excit¬ 
ing  inflammation  or  leaving  scars.  50  cents,  by  mail. 

No.  35.  Sanitary  Emulsion, 

A  moth  and  freckle  lotion,  to  clear  the  complexion,  which  it  does  by  erasing 
the  color-patches,  brown  stains  and  deposits  left  by  blood  impurities,  liver  torpor, 
etc.  It  thoroughly  cleanses  the  pores,  dissolves  hardened  secretions,  and  in  short 
helps  “  off  with  the  old  and  on  with  the  new  ”  cuticle.  50  cents,  by  mail. 

No.  36.  Depilatory  — A  True  Hair  Eradicator. 

.Removes  superfluous  hair ,  without  any  caustic  effect,  thus  avoiding  the  in¬ 
jurious  effect  of  the  ordinary  chemical  depilatories.  $1.00  per  box,  by  mail. 

i\n  1  For  threatened  Baldness,  poor  growth  of  hair,  and  all  scalp 
HU.  1 .  irritations,  we  offer  our  regular  Magnetic  Ointment  (No.  1)  as  the  best 
remedy,  and  can  show  the  finest  testimonials  to  its  usefulness  in  this  line.  25c., 
50c.,  $1.00;  by  mail;  (seepage  727).  Order  Dr.  Foote’s  No.  1  Hair  Pomade,  50  cents. 

No.  37.  Sanitary  Powder, 

Just  the  thing  for  sore  feet,  moist,  itchy  skin  surfaces,  chafing,  etc.  Handy 
for  ladies'  and  babies’  toilet;  also  for  barbers,  big  and  little  shavers.  Relieves  ten¬ 
der  feet,  moist  arm-pits  and  many  forms  of  skin  disease  needing  a  drying,  disin¬ 
fecting,  soothing  and  real  sanitary  influence.  Dispels  disagreeable  odors  of  the 
body;  substitutes  better  odor.  25  cents,  by  mail. 

SANITARY  BUREAU,  129  East  28th  St.,  New  York. 


A  family  Medical 

“d  Marriage  Guide 

NEW,  THOROUGH,  PRACTICAL  and  UP-TO-DATE 

This  Great  Work  --  Dr.  Foote’s  Latest  and  Best 

Embraces  all  the  popular,  useful,  and  original  matter  of  his  earlier  writings 
HEDICAL  COMMON  SENSE  and  PLAIN  HOME  TALK 
which,  being  entirely  revised,  enlarged,  and  reset  in  new  type,  now  appears  in  one 

Handsome  Cloth-bound  Volume  of  1248  pages, 

Embellished  with  over  400  illustrations, 

Including  18  full-page  color  plates,  with  80  pictures, 

And  a  Chapter  of  250  Prescriptions. 

Popular  Edition,  $2.  Standard  Edition,  $3 ;  in  Leather,  $4, 

Murray  Hill  Pub  Co.,  129  East  28th  Street,  New  York. 


CONTENTS. 

THE  READER  IS  RECOMMENDED  TO  CONSULT  FREELY  THE  INDEX  AT 
THE  END  OF  THE  BOOK,  WHICH  HAS  BEEN  SO  PREPARED 
THAT  HE  CAN  FIND  ALMOST  ANY  SUBJECT 
HE  MAY  BE  IN  SEARCH  OF. 

PART  I. 


DISEASE:  ITS  CAUSES,  PREVENTION 

AND  CURE. 


OPENING  CHAPTER. 

PAGE 

Disease  and  Its  Causes . .  15 

The  Causes  of  Disease,  16  ;  Nervous  Telegraphy,  18  ;  Mental  Disturbances, 

20  ;  Blood  Derangements,  23  ;  The  Germ  Theory,  26  ;  A  Prophetic  Article, 

27  ;  Germs  of  Malaria,  31  ;  Cheese  and  Butter-making  Germs,  etc.,  32  ;  Are 
Germs  Producers  or  simply  Bearers  of  Disease?  34. 

CHAPTER  II. 

The  Causes  op  Nervous  Derangements  and  Affections  of  the  Blood .  37 

Ignorance,  37  ;  Real  Ignorance,  39  ;  Air  Brakes  on  the  Car  of  Knowledge, 

42 ;  False  Modesty  Leads  to  Hygienic  Error,  42 ;  Violating  the  Moral 
Nature,  44  :  How  it  was  viewed  by  a  Noted  Preacher,  46 ;  No  Great  Names 
on  Fences.  48 ;  The  Food  We  Eat,  51  ;  The  Pork  Parasite  Causes  Interna¬ 
tional  Controversy,  57  ;  A  Hog  would  become  Diseased  by  Eating  Man,  59  ; 
Hog  and  Hominy  in  Old  Kentuck,  60;  Plenty  of  More  Wholesome  Food, 

62  ;  Facts  Regarding  Vegetable  Diet,  65  ;  How  the  Killing  is  Done,  70  ; 
Cannibalism  Within  the  Human  Body,  72 ;  Food  for  the  Fat  and  Food  for 
the  Lean,  73  ;  A  Brief  Word  to  the  Lean,  75  ;  Beware  of  Fads,  76 ;  Good 
Digestion  the  Main  Thing,  82  :  A  Few  Danger  Signals,  82 ;  Winged  Scaven¬ 
gers,  84  ;  The  Liquids  We  Drink,  93 ;  Tea  and  Coffee,  95  ;  How  Tea  Should 
be  Prepared,  97 ;  English  Chicory,  98  ;  Alcoholic  Drinks,  99  ;  Doctors  Disa¬ 
gree,  101 ;  Uses  and  Abuses  of  Alcohol,  104  ;  Drunkards  are  not  Properly 
Treated,  106  ;  Milk  is  the  First  Fluid,  107  ;  An  Ideal  Stable  for  Cows,  108  ; 
How  to  Purify  Milk,  111;  Milk  Should  not  be  Boiled,  114  ;  Reliable  Milk  is 
Coming,  115  ;  Kumyss,  Buttermilk,  etc.,  117  ;  Nature’s  Beverage— Water, 
119;  Precautions  to  be  Taken,  120;  A  Noted  Writer  in  Error,  124;  The 
True  Value  of  Water,  126  ;  The  Atmosphere  We  Live  In,  129;  Electrical 
Radiation,  132  ;  Erroneous  Philosophy  Corrected,  135  ;  Proper  Management 
in  Cold  Weather,  138  ;  Importance  of  Careful  Ventilation,  139 ;  Our  Meth¬ 
ods  of  Heating,  141  ;  The  Clothes  we  Wear,  146  ;  Not  Robust  Enough  for 
Bloomers,  149  ;  Low-Neck  Dresses,  153  ;  About  the  Costumes  of  Men,  155  ; 
Knit  Suits,  Rubber  Garments,  and  Footgear,  155  ;  Second-hand  Clothing 
and  Shoddy,  159  ;  Bad  Habits  of  Children  and  Youth,  160 ;  Bad  Habits  at 
School,  162  ;  Going  “  Barefoot,”  164  ;  Sleeping  with  Elder  Persons,  165  ;  A 


CONTENTS. 


vii 


Destructive  Habit,  167;  Standing  on  the  Head,  170;  The  Cigarette  Habit, 
170;  Bad  Habits  of  Manhood  and  Womanhood,  173;  Poisonous  Properties 
of  Tobacco,  175;  Health  Hints  to  Smokers,  179;  Intemperance  in  the  use 
of  Ardent  Spirits,  180;  Bad  Habits  in  Dress,  181;  A  Natural  Waist,  182; 
The  Drug  Habit,  186;  Human  Night-Hawking,  189;  Fast  Eating,  191;  Big 
Dinners,  193;  Social  Magnetism  versus  Sexual  Isolation,  195;  Where  the 
Effects  of  Isolation  may  be  Seen,  198;  What  Happens  in  Cities,  200;  The 
Secret  of  Sexual  Attraction,  204;  Prostitution,  205;  How  it  Affects  the 
Innocent,  208;  State  Regulation  of  Prostitution,  212;  Some  of  the  Avoid¬ 
able  Causes  of  Prostitution,  218;  Unhappy  Marriage,  225;  Impure  Vacci¬ 
nation,  228;  Adulterated  Medicines,  233;  Adulterations  of  Mineral  Medi¬ 
cines,  235;  Brutality  and  Inhumanity,  236;  Man’s  Inhumanity  to  Man,  237; 
The  Death-Penalty  Must  Go,  239;  Medical  Societies  Oppose  the  Death- 
Penalty,  241 ;  Is  the  peath-Penalty  a  Deterrent?  243;  Wealth,  246;  Failures 
in  Business,  249;  Excessive  Study,  251 ;  Excessive  Labor,  252;  Worry,  254; 
Melancholy,  257. 


CHAPTER  III. 


PAGE 


Prevention  op  Disease 


259 


How  to  Have  Healthy  Babies,  262;  Hints  to  Parents  in  Average  Health, 
264;  The  Secretions  are  Affected  by  Mental  Conditions,  265;  Advice  to  the 
Pregnant,  265;  Some  General  Hints,  267;  How  to  Preserve  the  Health  of 
Children,  268;  Their  Little  Legs  Need  Clothing,  270;  How  Babies  Should  be 
Fed,  272;  Bathing,  Exercising,  Dosing,  etc..  273;  The  Education  of  an 
Infant,  276;  “Don’ts”  for  the  Nursery,  276;  Dietetics  for  Old  and  Young. 
277;  The  Physiological  Instruction  of  Children,  281;  Mental  and  Physical 
Recreation,  282;  Bicycle  Exercise,  290;  “  Shut  Your  Mouth,”  294;  Sleep, 
295;  Cleanliness,  298;  Pure  Air,  300;  Sunshine,  302;  Good  Temper,  306; 
Keep  the  Feet  Warm,  307;  Other  Suggestions,  311. 


CHAPTER  IV. 


Common-Sense  Remedies .  312 

Vegetable  Medicines,  313;  Medicine  in  Ye  Olden  Time,  316;  The  Self -Cure 
of  Animals,  320;  Revolution  in  the  Practice  of  Medicine,  321 ;  Will  Vege¬ 
table  Medicines  Drive  out  Microbes?  323;  Psychic  Medicine,  Christian 
Science,  Mental  Science,  etc.,  etc.,  323;  Humor  Superstitions,  327;  Thera¬ 
peutic  Electricity,  329;  Are  not  Nerve-Force  and  Electricity  the  Same? 

332;  The  Therapeutic  Value  of  Electricity,  335;  Electricity,  to  be  Effect¬ 
ual,  Must  be  Properly  Applied,  337;  Animal  Magnetism,  343;  The  Begin¬ 
ning  of  Mesmerism.  344;  More  Recent  Investigations,  345;  How  are  these 
Mesmeric  Cures  Effected?  347;  Water,  352;  Medicated  Inhalation,  356; 
Conclusion,  357. 

CHAPTER  V. 


Doctors .  358 

Doctors  “Jacks  at  all  Trades,”  361;  Should  we  have  Women  Doctors? 

363;  Rapacious  Doctors,  367;  Doctors  who  Bank  on  the  Reputations  of 
Others,  371 ;  More  Pretenders,  374. 

PART  II. 


CHRONIC  DISEASES;  THEIR  CAUSES  AND  SUCCESSFUL  TREATMENT, 

WITH  A  CLOSING  CHAPTER 

CONTAINING  NUMEROUS  PRESCRIPTIONS  FOR  COMMON  AILMENTS,  ANTIDOTES  FOR 
POISONS,  VALUABLE  SUGGESTIONS  FOR  EMERGENCIES,  ETC. 

OPENING  CHAPTER. 

.  PAGE 

Chronic  Diseases . 877 

What  is  a  Chronic  Disease?  380;  Various  Kinds  and  Signs  of  Chronic  - 
Disease,  383;  The  Personal  Equation,  387;  Functional  and  Organic,  390. 


Vlll 


CONTENTS. 


CHAPTER  II. 

PAGE 

Chronic  Diseases  op  the  Breathing  Organs .  892 

Chronic  Catarrh  of  the  Head,  395;  Influenza-Catarrhs,  400;  Hay  Fever,  402; 
Nasal  Polypi,  403;  Chronic  Affections  of  the  Throat.  403:  Chronic  Bron¬ 
chitis,  408;  Asthma,  411;  Consumption,  413;  Koch’s  Bacilli,  414;  “Is  Con¬ 
sumption  Hereditary?”  416;  The  Curability  of  Consumption,  420;  Treat¬ 
ment  of  Chronic  Diseases  of  the  Breathing  Organs,  421;  Koch’s  Serum  and 
other  Remedies,  423;  Climatic  Influences  Considered,  426;  Artificial  Infla¬ 
tion  of  the  Lungs.  428;  Deep-Breathing  and  Chest  Exercise,  428;  Living 
with  One  Lung,  433;  The  Main  Thing  to  Affect  a  Cure,  435. 

CHAPTER  III. 

Diseases  op  the  Heart  and  Blood-Vessels .  436 

Palpitation  of  the  Heart,  440;  The  Tobacco  Heart,  442;  Angina  Pectoris, 

443;  Diseases  of  Blood-Vessels,  444;  Aneurism,  445;  Apoplexy,  447;  Vari¬ 
cose  Veins,  448.  I 

CHAPTER  IV. 

Chronic  Diseases  op  the  Liver,  Stomach,  and  Bowels .  449 

Chronic  Affections  of  the  Liver,  451 ;  Where  Torpid  Livers  are  Found,  452; 

Why  the  Negro  is  more  Enduring  in  the  Tropics,  453;  Liver-Torpor  Com¬ 
mon  in  New  Countries,  454;  Other  Diseases  may  Result  from  Neglect  of 
the  Liver,  457;  Bilious  Headache,  459;  Gall-Stones,  461;  Dyspepsia,  463; 

The  Horrors  of  Dyspepsia,  466;  Importance  of  Salivary  Digestion,  467; 
Intestinal  Indigestion,  469;  Good  and  Bad  Ferments,  471:  Suggestions  for 
Treatment,  472;  Aids  to  Digestion,  473;  Constipation,  477;  The  Treatment 
of  Constipation,  481;  Injections  and  Purgatives,  485;  Spring  Disorders  and 
Loss  of  Appetite,  486;  Chronic  Diarrhoea,  488:  Hemorrhoids,  or  Piles,  490; 
Falling  of  the  Rectum,  495;  Stricture  of  the  Rectum,  495;  Fistula-in- Ano, 

496;  Fissure  of  the  Anus,  497;  Intestinal  Parasites,  498;  Hernia,  or  Rupture, 

500;  Inconvenience  and  Danger  of,  504. 

CHAPTER  V. 

Chronic  Afpections  of  the  Urinary  Organs .  506 

Diseases  of  the  Kidneys,  508:  Bright’s  Disease,  508;  Bicycles  and  Bright’s 
Disease,  513;  The  Curability  of  Bright’s  Disease,  513;  Further  on  the 
Hygiene  of  Bright’s  Disease,  516;  Medical  Treatment  of  Bright’s  Disease, 

517;  Kidney  Colic,  or  Gravel,  518;  Cystitis,  518;  Enlarged  Prostate,  520; 
Incontinence  of  Urine,  etc.,  520;  Urethritis,  Gonorrhoea,  Gleet,  Stricture, 

522;  Treatment  for  Such  Cases,  526. 

CHAPTER  VI. 

Private  Words  for  Women .  530 

Concerning  Causes  of  Uterine  Diseases,  534;  Contagious  Venereal  Dis-' 
eases,  540;  Diseases  Resulting  from  Child-Bearing  and  Abortion,  540; 
Derangements  of  the  Monthly  Flow,  543;  Irregular  and  Painful  Menstrua¬ 
tion,  545;  Suppressed  Menstruation,  547;  Leucorrhoea,  548;  Falling  of  the 
Womb,  557;  Ulceration  of  the  Womb,  564;  Polypus  of  the  Womb,  564; 
Dropsy  of  the  Womb,  565:  Chronic  Inflammation  of  the  Womb,  566; 
Vaginal  Affections,  566;  Nymphomania.  567;  Amorous  Dreams,  569; 
Anthropophobia  and  Sexual  Apathy,  571 :  Sexual  Dyspepsia,  571 ;  Ovarian 
Diseases,  573;  Treatment  of  Diseases  of  Women,  573. 

CHAPTER  VII. 

Hints  to  the  Childless .  576 

The  Causes  of  Barrenness,  581 ;  Local  Inadaptation,  581 ;  Diseased  Condition 
of  the  Wife,  588;  More  Interesting  Facts  About  the  Ovaries,  593;  Are  the 
Ovaries  Essential  for  the  Maintenance  of  Sexual  Desire?  595;  Diseased 
Condition  of  the  Husband,  596;  Excessive  Amativeness,  599;  Tempera¬ 
mental  Inadaptation,  601;  How  to  Promote  Child-bearing,  604;  Importance 
of  Overcoming  Local  Inadaptation,  607;  More  Valuable  Hints  for  Over¬ 
coming  Barrenness,  609:  When  Disease  is  the  Cause  of  Sterility,  610;  When 
Unfruitfulness  is  Caused  by  Temperamental  Inadaptation,  612;  A  Word  to 
Jealous  Husbands,  613. 


CONTENTS 


IX 


CHAPTER  VIII. 

PAGE 

Private  Words  for  Men . . .  616 

The  Penis  and  its  Diseases,  617;  Phimosis,  622;  The  Scrotum  and  its  Dis¬ 
eases.  625;  The  Testicles  and  their  Diseases,  625;  Enlargements  of  the 
Testicular  Glands,  629;  Hydrocele,  630;  Varicocele,  630:  Seminal  Weak¬ 
ness,  632;  My  Views  Endorsed,  636;  Two  Kinds  of  Spermatorrhoea,  638; 
Complicated  Spermatorrhoea,  639:  The  Treatment  of  Spermatorrhoea,  643; 
Inflammation  of  the  Prostate  Gland  and  Seminal  Vesicles,  644;  Satyriasis, 

646;  Sexual  Perverts  and  Degenerates.  649;  “As  the  Twig  is  Bent,  the 
Tree  Inclines,'”  650;  Dangers  of  School-Life,  651;  Other  Sources  of  Con¬ 
tamination,  652. 

CHAPTER  IX. 

Impotenct .  655 

May  Affect  Either  Sex,  657;  Mental  as  Well  as  Physical  Causes,  659;  Imag¬ 
inary  Impotency,  662;  Physical  Causes,  663. 

CHAPTER  X. 

Affections  of  the  Nerves,  Blood,  and  Skin . . . . . . .  668 

Affections  of  the  Nerves,  669;  Neurasthenia,  671 ;  Burning  the  Candle  at 
Both  Ends,  672;  Hypochondria,  674;  Hysteria,  674;  Treatment  of  Neuras¬ 
thenia,  Hypochondria,  and  Hysteria,  675;  Paralytic  Affections,  679;  Facial 
Paralysis,  680;  Shaking  Palsy,  681;  Locomotor  Ataxy,  681;  Epilepsy,  681 ; 

The  Question  of  Functional  or  Organic  Disease,  684;  Scrofula,  687;  Symp¬ 
toms  and  Treatment  of  Scrofula,  689;  Aches  and  Pains.  691;  Nervous 
Headaches,  692;  Congestive  Headache,  693;  Neuralgia,  694;  The  Treat¬ 
ment  of  Neuralgia,  696;  Rheumatism,  697;  Treatment  of  Rheumatism,  698; 
Gout,  700;  The  Treatment  of  Gout,  700;  Cancer,  701;  The  Treatment  of 
Cancer,  703;  Syphilis,  705;  Its  Progress,  707;  Its  Treatment,  709;  Skin  Dis¬ 
eases,  710;  The  Main  Affections  Described,  711;  The  Causes,  712;  Urticaria 
—Hives,  713;  Rosacea,  713;  Pruritus— Itching,  714;  Herpes,  714;  Eczema- 
Salt  Rheum,  715;  Other  Scaly  Skin  Diseases,  716;  Comedones,  Black-heads, 
Worms,  717;  Acne,  718;  Boils— Carbuncles,  718;  Parasitic  Skin  Diseases, 

719;  Pediculi— Lice,  720;  Tinea  Trichophytina— Ringworm,  720;  Tinea 
Versicolor— Pityriasis,  721;  How  to  Cultivate  Beauty  of  Face,  721;  Health 
the  Basis  of  Beauty,  724;  Face  Recipes,  727;  Baldness,  727. 

CHAPTER  XI. 

Affections  of  the  Eyes  and  Ears .  730 

Nature’s  Photographic  Camera,  730:  How  Old  Eyes  can  be  Restored,  734; 
Near-sight  or  Myopia,  736;  Other  Optical  Defects,  737;  Diseases  of  the 
Eyes,  738;  Chronic  Sore  Eyes,  740;  Cross  Eyes,  743;  Other  Diseases  of  the 
Eye,  744;  Defective  Hearing,  744. 

CHAPTER  XII. 

Treatment  of  Disease . . . . .  751 

Everybody  His  Own  Doctor,  752:  Dietetics,  756;  Clear  Conscience  Better 
than  a  Petted  Stomach,  757;  Warranting  Cures,  759;  To  Consultants,  760; 

List  of  Questions,  761 ;  Evidences  of  the  Curability  of  Chronic  Diseases, 

763;  Affidavits  of  the  Drs.  Foote,  765;  Cases  of  Diseases  of  the  Breathing 
Organs, -766;  Cases  of  Diseases  of  the  Digestive  Organs,  767;  Cases  of  Ner¬ 
vous  Diseases,  768;  Cases  of  Diseases  of  the  Urinary  Organs,  769;  Another 
Case  of  Bright’s  Disease,  770;  Cases  of  Diseases  of  Men,  770;  Cases  of  Dis¬ 
eases  of  Women.  773;  Cases  of  Barrenness,  7~5;  Born  by  the  Book,  775; 
Miscellaneous  Diseases,  777:  Earlier  Triumphs,  779;  A  Bedridden  Case, 

779;  Concluding  Remarks,  781. 

CHAPTER  XIII. 

Two  Hundred  and  Fifty  Prescriptions  for  Common  Ailments  and 
Suggestions  for  Emergencies. 


Preliminary  Remarks .  782 

Antidotes  for  Poisons,  799;  Rules  for  Resuscitating  the  Drowned,  801; 
What  to  do  When  the  Patient  Begins  to  Breathe,  804 ;  The  Care  of  Babies. 

804. 


CONTENTS. 


PART  III. 

PLAIN  TALK  ABOUT  THE  SEXUAL  ORGANS;  THE  NATURAL  RELA¬ 
TIONS  OF  THE  SEXES:  CIVILIZATION,  SOCIETY, 

AND  MARRIAGE. 


OPENING  CHAPTER. 

PAGE. 

Introductory  Words  .  807 


CHAPTER  II. 


The  Sexual  Organs . . . . .  810 

The  Cause  of  Their  Disgrace,  810;  Pacts  Regarding  Pagan  Worship,  811; 
Their  Influence  on  Physical  Development,  814;  Their  Influence  on  Health, 

818;  Every  Faculty  and  Organ  Necessary,  821;  How  They  are  Made  Instru¬ 
ments  of  Conjugal  Association,  825;  Individual  Electricity,  826;  Chemical 
Electricity,  831:  Frictional  Electricity,  833;  How  They  are  Made  Instru¬ 
mental  in  Perpetuating  the  Race,  834;  The  Physiology  of  Reproduction, 

838;  Their  Influence  on  the  Social  Position  of  Woman,  840;  The  Real 
Causes  of  Rome’s  Fall,  842;  Their  Influence  on  Civilization,  846;  Polyandry 
and  Prostitution,  848. 


CHAPTER  III. 

History  of  Marriage .  852 

History  of  Polygamy,  853;  Hebraic  Polygamy,  856;  Grecian  Concubinage, 

859;  Persian  and  Mohammedan  Polygamy,  862:  Polygamy  in  the  New 
World,  865;  History  of  Mormon  Polygamy,  866;  Why  not  let  Woman  Suf¬ 
frage  Settle  the  Problem?  874;  History  of  Monogamy,  880;  Marriage 
Became  a  Passing  Union,  884;  Marriage  Among  the  Northern  Barbarians, 

886;  How  Marriage  in  the  Old  Empire  Flourished,  887;  Marriage  in  Ancient 
Scandinavia,  893;  History  of  Complex  Marriage,  894;  The  Children  of  the 
Community,  897;  What  a  Physician  saw  at  the  Oneida  Community,  899; 

The  Basic  Principles  of  the  Oneida  Community,  901;  Was  Mr.  Noyes’ 
Dream  Realized?  905;  Historical  Chips,  909. 

CHAPTER  IV. 

Marriage  as  it  is  in  Barbarism  and  Civilization .  921 

Marriage  in  the  Old  World,  921;  Marriage  in  the  New  World,  966;  Con¬ 
cluding  Remarks,  990. 

CHAPTER  V. 


Defects  in  Marriage  Systems .  992 

Demerits  of  Polygamy,  997;  Demerits  of  Monogamy,  998;  Demerits  of 
“  Complex  Marriage,”  1009. 

CHAPTER  VI. 

The  Remedy.  A  Chapter  full  of .  1012 

Original  and  Startling  Suggestions  for  Twentieth  Century  Readers. 

CHAPTER  VII 


Sexual  Immorality . 

The  Causes,  1025;  The  Cure  1028. 

CHAPTER  VIII. 


1024 


Conclusion  of  Part  Third 


1064 


CONTENTS.  il 

PART  IV. 


SUGGESTIONS  FOR  IMPROVEMENT  OF  MONOGAMIC  MARRIAGE,  ETC. 


OPENING  CHAPTER. 

Prefatory .  1041 

CHAPTER  II. 

Adaptation  in  Marriage .  1045 

What  is  Mental  Adaptation?  1050;  What  is  Physical  Adaptation?  1053; 

First,  the  Vital  Temperaments,  1056;  Second,  the  Non-Vital  Tempera¬ 
ments,  1059;  The  Mixture  of  Two  Temperaments,  1064;  The  Mixture  of 
Three  Temperaments,  1067;  The  Mixture  of  Four  Temperaments,  1069; 

Dr.  Powell’s  Six  Rules,  1078. 

CHAPTER  III. 

Restricted  Marriage  and  Parentage .  1081 

Restricted  Parentage,  1082;  A  Practical  and  Constitutional  Plan,  1090; 
Divorce,  1095. 

CHAPTER  IV. 

Three  Phases  of  Monogamic  Marriage  Photographed .  1100 

Mental  Marriages,  1101 ;  Physical  Marriages,  1103;  Wretched  Misfits,  1104. 

CHAPTER  V. 

Philosophy  of  Elopements .  1111 

CHAPTER  VI. 

Intermarriage  of  Relatives .  1117 

CHAPTER  VII. 

Essays  for  Married  People . 1121 

The  Wife  the  Equal  Partner,  1123;  Sleeping  Apart,  1127;  Sexual  Modera¬ 
tion,  1130;  Jealousy,  1134;  “Conjugal  Prudence,”  1136;  Contraceptics; 
Their  Value  in  Promoting  Human  Evolution,  1143;  Sexual  Indifference, 

1148;  Signs,  Symptoms,  and  Discomforts  of  Pregnancy,  1153;  Food  for 
Pregnant  Women,  1155;  Card  to  Married  People,  1156. 

CHAPTER  VIII. 

What  Determines  Sex? .  1158 

Professor  Schenk’s  Theory,  1159;  Many  Other  Theories,  1161. 

CHAPTER  IX. 

Philosophy  of  Child-Marking .  1164 

The  Phenomena  of  Child-Marking  Explained,  1168;  Why  Offspring  Resemble 
Both  Parents,  1168;  Why  they  Resemble  One  Parent,  1171;  Why  they  Resem¬ 
ble  Neighbors,  1171;  Why  Children  by  Second  Husbands  Resemble  the 
First,  1174;  How  Frights  Mark  a  Child,  1175;  Child-Marking  and  its  Influence 
on  Human  Evolution,  1177. 

CHAPTER  X. 

Essays  for  the  Future  on  Marriage  and  Parentage .  1178 

Early  Marriage,  1179;  What  is  a  Marriageable  Age?  1180;  Advantages  of 
Early  Marriage,  1182;  Children’s  Marriages,  1183;  Woman’s  Varied  Avoca¬ 
tions,  1187;  Prepare  the  Young  for  Early  Marriage,  1191;  Prepare  for  Parent¬ 
age,  1195;  Card  to  the  Unmarried,  1197. 

Index .  1198 

Advertisements  .  ,\ . . . . . .  12SS 


IliliOSTR  HTPI  □  ns 


FIGURE  PAGE 

1  Capitol  of  the  Nervous  System  16 

2  Professor  Brain’s  Telegraph . .  20 

3  The  Heart  and  Arteries .  22 

4  Diagram  of  Blood  Circulation  23 

5  Capitol  of  the  V ascular  System  24 

6  A  Frog’s  Foot .  25 

7  Bacteria . , .  28 

8  Laveran’s  Germs  of  Malaria. .  32 

9  White  and  Red  Corpuscles. ...  36 

10  Trying  to  Lift  Himself .  37 

11  The  Creature  of  Accident .  39 

12  Mother  Grundy  Blindfolds  the 

Mothers  of  the  Race,  and 
the  Children  too .  41 

13  A  Man  who  has  nearly  Worn 

Himself  out  in  the  Service 
of  the  Devil .  45 

14  One  who  has  Gained  not  only 

Avoirdupois,  but  Intelli¬ 
gence  and  Goodness .  46 

15  “The  Reverse.  Behold  the 

Contrast” .  47 

16  Goddess  of  Justice .  50 

17  “  Plying  Knife  and  Fork .  52 

18  An  International  Provision 

Store .  53 

19  The  Use  of  Swine .  55 

20  Trichinas,  Cysts  and  Meat....  58 

21  Encysted  Trichinas  in  Muscle.  59 

22  The  Unhealthy  Pair .  60 

23  Infected  Muscle .  61 

24  Sheep— Wholesome  to  the  Eye  63 

25  The  Vegetarian  Bicyclist .  66 

26  The  Vegetarian  Pedestrian. . .  67 

27  Vegetable  Food .  69 

28  The  Animals  we  Slaughter  ...  71 

29  Somewhat  Weighty .  74 

30  Thin !  Too  Thin ! .  75 

31  A  Public  Dining  Room .  78 

32  A  Little  Death-Trap .  83 

33  The  House  Fly .  85 

34  The  House  Fly’s  Foot  Plas¬ 

ters  Microbes  on  our  Faces  86 

35  Common  Field  Mushroom — 

Edible .  89 

36  The  Liquids  we  Drink .  94 

37  Tea  Plant.. .  97 

38  The  Man  who  Drinks  Modern 

Liquors . * .  100 

39  The  Temperate  Man .  102* 

40  The  Autumn  of  a  Temperate 

Life .  102 

41  Teeth  of  a  Grazing  Cow .  109 

42  Teeth  of  a  Stall-fed  Cow .  109 

43  A  Familiar  Scene  on  the  Farm  111 

44  Firs  t-class  Palace  for  the  Kine  116 

45  The  Old  Oaken  Bucket .  120 


FIGURE  PAGE 

46  Nature’s  Beverage  on  a  Frolic  121 

47  Some  Denizens  of  Pond .  126 

48  Our  Planet  and  its  Atmosphere  129 

49  Electricity  of  the  Thunder 

Storm .  131 

50  Electrical  Radiation .  133 

51  Sweat  Glands .  135 

52  Old-fashioned  Fire-place .  142 

53  How  we  come  into  the  World.  146 

54  Loose-fitting  Garments  of  Japs  148 

55  Amelia  Bloomer  in  her  Orig¬ 

inal  Costume  of  1851,  Con¬ 


trasted  with  1899 .  152 

56  The  Costumes  of  UncleSam’s 

Numerous  Family .  156 

57  Various  Inventions  for  the 

Feet .  158 

58  Little  Barefooted  Candy-eater  161 

59  Bad  Position  in  Sitting .  163 

60  Smoking  and  Snuffing .  173 

61  First  Lesson  in  Smoking .  174 

62  Defective  Sticks .  179 

63  Positions  of  the  Diaphragm  . .  181 

64  A  Contracted  Waist . .  183 

65  A  Natural  Waist .  183 

66  Fragment  of  Ancient  Venus  . .  184 

67  The  Salivary  Glands .  192 

C8  These  are  fit  for  a  Feast .  194 

69  The  Isolated  Girl .  196 

70  Social  Magnetism .  200 

71  Innocent  Girl  Changed  by  Vice  206 

72  Night  Scene  in  “Suicide  Hall”  207 

73  Reward  Offered  for  Vice .  218 

74  Want  and  Threatened  Starva¬ 
tion  Held  out  to  Virtue .  219 

75  LTnhappy  Marriage .  226 

76  Jenner  Vaccinating  his  Child.  229 

77  The  Hand  that  does  it .  233 

78  An  Illustration .  236 

79  General  N.  M.  Curtis .  240 

80  The  Electrocuting  Chair . .  244 

81  Horn  of  Plenty .  247 

82  Othello’s  Occupation  Gone.. . .  249 

83  The  Student  at  his  Books .  252 

84  The  Overworked  Man .  253 

85  A  Worrying  Woman .  254 

86  The  Melancholy  Man .  257 

87  A  Cure  for  Melancholy .  258 

88  A  Cluster  of  Babies .  266 

89  Triumphant  Baby  and  Mother  270 

90  Editor's  Plan  for  Diverting  the 

Baby .  275 

91  A  Healthy  Mother  and  Child. .  278 

92  Magnetic  Exercise .  283 

93  Coming  Ladies  on  Horseback  285 

94  The  Swimmer .  288 

95  A  Group  of  Cyclers .  201 

xii 


ILLUSTRATIONS. 


FIGURE  PAGE 

96  All  Asleep . . .  296 


97  Perspiratory  Gland  and  Tube.  298 

98  This  is  how  an  Enclosed  Ver¬ 

anda  Looks  on  the  Outside..  804 

99  Warming  Feet  Magnetically. .  310 

100  A  Specimen  of  what  Nature 

Produces  in  her  Laboratory.  314 

101  Botanic  Doctor  of  Ye  Olden 


Time .  317 

102  Nature’s  Laboratory— Good 

Food  and  Medicine .  320 

103  One  Corner  of  Dr.  Foote’s  Lab¬ 

oratory .  322 

104  Mrs.  Eddy,  Founder  of  Chris¬ 

tian  Science .  325 

105  Viewing  the  Moon  over  the 

Right  Shoulder .  327 

106  Electrical  Radiation  from  the 

Hand .  329 

107  Repellant  Electric  Waves  of 

the  Hand .  331 

108  Ordinary  Electro-magnetic 

Machine .  336 

109  Dr.  Foote’s  Office  Battery .  340 

110  Magnetic  Hands .  342 

111  Putting  a  Sensitive  Subject  to 

Sleep .  346 

112  Nerve  Atmosphere .  347 

113  .Japanese  Manipulators .  350 

114  Japanese  Manipulators .  351 

115  Priessnitz’s  Medicine .  353 

116  The  “Doctor”  in  the  Bow....  859 

117  The  Terrified  Lady .  368 

118  The  Abdominal  Cavity  Laid 

Open .  376 

119  Dr.  Foote’s  Offices  since  1887..  881 

121  Bow-legged  but  Healthy .  384 

122  Seems  Nervous .  385 

123  The  Octopus  of  Evil  Habits 

and  Victims  of  “High  Life ”  389 

124  Diagrammatic  Lung  and 

Structure .  393 


125  Respiratory  System  of  a  Tree.  894 

126  Respiratory  System  of  Man. . .  895 

127  The  Cavities  in  the  Bones  of 

the  Face  Subject  to  Catarrh  396 

128  Nostrils  as  Seen  from  Behind.  399 


129  Polypus  Tumor .  401 

130  The  Diseased  Throat .  403 

131  Nasal  and  Throat  Air-passages  405 

132  Laryngoscope .  406 

133  Vocal  Cords .  407 

134  Wind  Pipe  or  Bronchus  and 

Tubes .  409 

185  Typical  Case  of  Consumption  414 

136  Fungi,  or  the  Bacilli  of  Con¬ 

sumption .  415 

137  Taking  in  Tubercle  Germs. . . .  416 

138  The  Air  Sacs  of  the  Lungs. .. .  418 

139  The  Out-door  Cure .  424 

140  Getting  Fresh  Air .  425 

141  Chest  Exercises .  431 

142  Chest  Exercises .  431 

143  Lungs  and  Heart .  432 

144  The  Heart . :.  437 

145  Enlarging  his  Heart .  438 

146  The  Normal  Heart .  441 

1 47  Heart  in  Valvular  Disease ....  411 

148  Disease  of  a  Coronary  Artery  441 

149  Various  Forms  of  Aneurisms.  416 

150  Varicose  Veins  of  the  Leg. .. .  448 

151  Digestive  Machinery .  4.0  I 


xiii 


FIGURE  PAGE 

152  The  Ethiopian. . . . . .  454 

153  The  Caucasian . 455 

154  The  Under  Side  of  the  Liver..  456 

155  Bilious  Headache . . .  460 

156  Nerves  of  the  Stomach .  465 

157  The  Pancreas .  471 

158  Stomach  Washing .  474 

159  Stomach  Washing .  475 

160  Dr.  Tanner .  476 


161  Showing  how  the  Male  Organs 

are  Affected  by  Constipation  478 

162  Showing  how  Female  Organs 


are  Affected  by  Constipation  479 

163  A  Delicious-Looking  Medicine  482 

164  The  Danse  du  Ventre .  484 

165  Tumorous  and  Varicose  Piles.  491 

166  Rectum  laid  open  with  Piles..  494 

167  Complete  Fistula-in-Ano .  497 

168  Surgical  Examination .  497 

169  Magnified  Head  of  Tapeworm  499 

170  Where  Hernias  Occur .  502 

171-176  Progressive  Hernia .  503 

176A  Operation  for  Relief  of  Stran¬ 
gulated  Hernia .  505 

177  The  Human  Water  Works. . . .  507 

178  The  Kidney  Cut  Through .  509 

179  Kidney  Casts .  510 

180  Smooth— B 1  a  d  d  e  r  Stones— 

•  Rough .  519 

181  A  Soft  Catheter .  521 

182  Leucorrhoeal  Matter .  523 

183  Gonorrhoeal  Matter .  523 

184  Strictures  of  the  Urethra .  527 

185  Urinary  Fistula  Resulting 

from  Stricture  following 
Gonorrhoea .  529 

186  Organs  of  Woman  (Diagram¬ 

matic) .  532 

187  Another  Sketch  True  to  Life.  533 

188  Composite  Photograph .  535 

189  Room  for  Vital  Organs. .  536 

190  Vital  Organs,  Crowded .  537 

191  Wrong  Position . 538 

192  Right  Position .  538 

193  A  Mis-shapen  Form .  539 

194  Female  Organs  Exposed .  554 

195  Family  Syringe .  557 

196  Vaginal  Syringe .  557 

197  Womb  Falling  Forward  on 

Bladder . 558 

198  Womb  Falling  Backward  on 

Rectum .  559 

199  Procidentia .  560 

200  Some  of  the  Pessaries  in  Use..  562 

201  Dr.  Pott’s  Spring-stem  Pessary  564 

202  Abdominal  Supporter .  565 

203  Woman  as  Formed  by  Nature  572 

204  Woman  as  Deformed  by 

Fashion .  573 

205  A  Plain  Home  Talk  Baby .  578 

206  A  Plain  Home  Talk  Baby .  580 

207  Local  Inadaptation .  582 

208  Local  Inadaptation .  583 

209  Diseased  Ovary .  590 

210  The  Ovary  in  Health .  591 

211  The  Ovary  in  Old  Age . 592 

212  The  Spermatozoa . . .  598 

213  Temperamental  Inadaptation  600 

214  Temperamental  Inadaptation  601 
215-217  Dr.  Fallen’s  Operation  on 

the  Cervix .  607 

218  The  Prize  Microscope .  611 


ILLUSTRATIONS 


xir 


PIG.  ^  .  PAGE. 

219  A  Plain  Home  Talk  Baby .  614 

220  Vertical  Section  of  Male. Or¬ 

gans  . . .  61 7 

221  Chancre . 619 

223  Side-view  of  Male  Organs .  620 

224  Structure  of  the  Testicle .  626 

225  Male  Organs .  627 

226  French  Method  of  Ligating 

Varicocele .  631 

227  The  Testes  in  Health  and  Dis¬ 

ease .  632 

228  Spermatozoa,  etc .  640 

229  The  Prostate  and  Seminal 

Vesicles . 645 

229A  Rev.  Rudolph  Foith .  652 

229B  Oscar  Wilde .  653 

230  Womb,  Ovaries.  Fallopian 

Tubes,  etc .  657 

231  Front  View  of  Penis .  661 

232  Cause  of  Impotency  found  665 

233  Neuron  and  Nerve-Bulbs .  669 

234  Neuron .  685 

235  A  Case  of  Hemiatrophy  .  686 

236  Charles  Sprague,  the  Living 

Skeleton .  687 

237  Facial  Nerves .  694 

238  Rheumatism . 697 

239  A  Nest  of  Cancer  Cells .  703 

240  Gummy  Tumors .  708 

241  A  Magnified  Cross  cut  of  Skin  711 

242  Demodex  Magnified  200  Times  718 

243  Burrow,  Itch-mite,  and  Eggs. .  719 

244  Pediculus  Pubis .  721 

245  Fair  and  Spotless .  722 

246  Nose  made  from  Forehead... .  723 

247  Nose  made  from  the  Arm .  724 

248  Jo-Jo  the  Dog-faced  Boy .  725 

249  Horn  on  Forehead .  726 

250  Hair  in  its  Follicle .  728 

251  Hairy  Nsevus .  729 

252  Vertical  Section  of  the  Eye. . .  731 

253  An  Eye  with  Proper  Convexity  732 

254  Too  Great  Convexity .  733 

255  Cornea  too  Flat .  734 

256  Application  of  Fingers  for 

Near-sight .  736 

257  Examining  with  Ophthalmo¬ 

scope .  739 

258  Mechanism  of  the  Eye .  741 

259  Cross  Eyes .  743 

260  The  Human  Ear .  746 

261  Rescuing  the  Drowned .  802 

262  Rescuing  the  Drowned .  803 

262A  Civilization  of  To-day .  866 

263  The  Seed  of  the  Oak  and  of 

the  Plum-tree .  814 

264  Is  it  Charlie  or  is  it  Mary  ?. . . .  815 

265  The  Female  Venus  de  Medici; 

The  Male  Apollo  Belvedere.  819 

266  The  late  Henry  Ward  Beecher  822 

267  A  Magnetized  Cane  Dance. . . .  828 

268  John  Randolph .  831 

269  Spermatozoon .  836 

270  Some  New  American  Citizens.  843 

270A  Mrs.  Frances  A.  Lee .  851 

271  The  Polygamic  Family .  855 

272  Joseph  Smith  the  Prophet _  868 

273  Brigham  Young .  869 

274  Part  of  President  Lorenzo 

Snow’s  Family .  871 

275  A  Utah  State  Senator .  875 


FIG.  PAGE. 

276  The  Sultan  of  Sulu .  87S 

277  A  Glimpse  of  Salt  Lake  City 

—  Wahsatch  Mountains .  878 

278  The  Monogamic  Family .  881 

279  Group  of  Oneida  Communists.  896 

280  First  Child  born  in  the  Com¬ 

munity  .  898 

281  A  Stirpicultural  Youth .  899 

282  The  late  Rev.  J.  H.  Noyes _  903 

283  Oneida  Community  Mansion. .  907 

284  Historical  Chips .  910 

285  Chinese  Marriage .  924 

286  Japanese  Official  and  Family..  926 

287  Japanese  Girl .  928 

288  Persian  Lady .  937 

289  Mrs.  Abdul  Hamid  Le  Mesur- 

rici*.  939 

29C  Zulu  Doctor .  945 

291  Wife  of  Oom  Paul .  946 

292  English  Girl .  948 

293  Victoria  in  the  Prime  of  Life..  951 

294  A  French  Actress .  954 

295  A  Finnish  Woman .  960 

296  A  Turkish  Lady .  964 

297  A  Male  Eskimo . 968 

298  A  Female  Eskimo .  969 

299  A  Greenlander .  970 

300  Fruits  of  Uncongenial  Mar¬ 

riage  .  978 

301  The  Late  Princess  of  Hawaii .  980 

302  A  Lady  of  Porto  Rico .  982 

303  A  Mestizo  Girl .  989 

304  Jesus  and  the  Accused  Woman  994 

305  First  Five  Years  of  Marriage  .  1006 

306  Five  Years  Later, . 1006 

306A  Enmeshed  in  Cupids  Bonds  1011 

307  Clothes  of  One  Size  and  Pat¬ 

tern  for  the  Million .  102C 

308  Affectionate  Husband  and 

Wife .  i027 

309  A  Typical  Libertine.. .  1032 

310  Mental  Organization .  1051 

311  Sanguine  Temperament .  1054 

312  Bilious  Temperament .  1055 

313  Profile  of  the  Nose .  1056 

314  Lymphatic  Temperament .  1058 

315  Encephalic  Temperament. . . .  1056 

316  General  Jackson .  1064 

317  Daniel  Defoe . 1065 

318  P.  T.  Barnum .  1068 

319  J.  Minor  Potts .  1067 

320  Rubens,  the  Painter . 1068 

321  Daniel  Webster .  1069 

322  Napoleon  the  First . 1070 

323  Sir  Walter  Scott .  1071 

324  Benjamin  West .  1072 

325  Dr.  William  Byrd  Powell _  1073 

326  The  Only  Members  of  the 

Italian  Family  allowed  to 

Remain .  1083 

326A  Eloping  in  1900 .  1116 

327  The  Apple .  1126 

328  Jealousy .  . .  1136 

329  Adaptation  and  Inadaptation 

Illustrated .  i  iol 

329A  Plain  Home  Talk  Babies. . . .  1157 
329B  Boy  or  Girl,  which  ? . 1163 

330  Horseshoe  Magnet .  1170 

331  A  Magnetic  Hammer .  1171 

332  Girls  on  Parade .  1190 


READ  WHAT 


r\ 


Physicians,  Clergymen,  Editors, 

AND 


HAVE  SAID  OF  PREVIOUS  EDITIONS  OF  DR  FOOTE'S 

Plain  Home  Talk  and  Medical  Common  Sense 


Review  of  “Plain  Home  Talk,’'  by  the  eminent  English  Physician , 
Essayist,  and  Reviewer,  the  late  Professor  Strauss. 

Near  the  close  of  September,  1887,  a  cablegram  announced  the  death  of  Dr.  G. 
L.  M.  Strauss,  of  London,  England,  a  savant  well  known  to  scientists  and  people 
of  literary  tastes.  The  following  review  of  the  field  of  medicine  is  from  an  unpub¬ 
lished  manuscript  received  a  few  years  ago  by  Dr  Foote,  Sr.  It  was  originally 
written  as  a  preface  to  the  English  edition  of  “  Plain  Home  Talk,  embracing 
Medical  Common  Sense.11  If,  as  was  intended  at  that  time,  stereotyped  plates  had 
been  used  in  London  for  the  special  English  edition,  the  manuscript  might  have 
been  so  used  ;  but,  for  English  publishers,  it  was  decided  best  to  continue  to  fur¬ 
nish  the  work  in  printed  sheets,  and  the  length  of  [Professor  Strauss’s  article  ren¬ 
dered  it  hardly  suitable  for  the  entire  edition  printed  for  use  on  this  as  on  the 
other  side  of  the  Atlantic.  The  whole  article  was  printed  in  the  November,  1887, 
issue  of  Dr.  Foote’s  Health  Monthly ,  and  that  portion  referring  directly  to  this 
book  is  such  a  valued  endorsement  of  it,  from  an  unquestionably  competent  and 
high  authority,  that  it  is  printed  herewith  as  a  suffix  instead  of  where  a  preface 
belongs. 

Professor  Strauss  wrote  : 

“In  limine,  I  must  crave  to  explain  briefly  how  I  came  to  volunteer  to  write 
this  Preface  to  the  new  English  edition  of  Dr.  Edward  B.  Foote’s  ‘Plain  Home 
Talk.1  - 

“  Up  to  some  thirty  months  or  so  ago  Dr.  Foote  was  personally  unknown  to 
me,  nor  had  I  read  a  line  of  his  books,  though  I  had,  indeed,  for  years  past,  heard 
much  of  him  and  his  great  success  in  his  professed  Common  Sense  treatment  of  an 
almost  all-embracing  variety  of  human  ailments.  With  a  pretty  long  and  not 
altogether  uneventful  professional  career  of  my  own  lying  behind  me,  I  continue 
to  take  a  warm  interest  in  all  genuine,  bona  fide  progress  of  the  most  important  of 
all  sciences— Physic. 

“  But  I  must  confess  that  my  experiences  in  that  noble  science,  and  with  its 
professors  and  leaders,  rather  tended  to  predispose  me  to  look  with  skeptic 
suspicion  upon  all  claims  and  claimants  to  exceptional  success  in  the  treatment  of 
diseases. 

1231 


1232 


ADVERTISEMENTS. 


“I  may  conscientiously  aver  that  I  have,  from  an  early  period  of  my  life, 
striven  hard  and  with  honest  endeavors  to  acquire  and  practise  the  beneficent 
healing  art.  I  have  been  privileged  to  sit  at  the  feet  of  many  a  reputed  Gamaliel 
of  the  vEsculapian  science.  I  studied  Physic  under  the  great  leaders  and  teachers 
of  the  most  renowned  schools  and  systems  of  my  time,  in  Germany  as  well  as  in 
France— and  in  many  a  civil  and  in  many  a  military  hospital  k's  the  sad  opportun¬ 
ity  been  most  profusely  offered  me  to  see  daily  and  hourly  proof  of  the  hopeless 
helplessness  of  the  vaunted,an>?  medendi ,  and  to  find,  to  my  most  bitter  grief  and 
deepest  humiliation,  that  most  of  the  fancied  theoretic  lore  I  had  acquired  turned 
out  in  the  crucible  of  attempted  practical  application  like  unto  dry  bones,  sapless 
chips,  withered  leaves,  and  burnt-out  ash. 

“  *  *  *  I  was  led  in  the  end  to  forsake  the  exercise  of  Physic  as  an  un¬ 
grateful  occupation,  and  to  take  to  pursuits  less  fraught  with  danger  and  incon¬ 
venience  to  my  fellow-men.  Now,  with  these  notions  of  mine,  it  was  but  natural, 
I  think,  that,  as  I  have  stated  at  the  outset,  I  should  feel  rather  disposed  to  look 
with  sceptic  suspicion  upon  all  claims  and  claimants  to  exceptional  success  in  the 
treatment  of  diseases.  I  must  once  more  observe  here  that  at  that  time  Dr.  Foote 
was  personally  unknown  to  me,  and  that  I  had  never  seen  a  line  of  his  medical 
writings.  * 

“  Now  it  so  fell  out  that  a  young  friend  of  mine,  who  had  heard  of  Dr.  Foote, 
and  who  had  unsuccessfully  tried  the  ministrations  of  some  of  our  most  highly 
reputed  doctors  in  a  delicate  case,  was  induced  at  last  to  consult  the  famous  New 
York  physician.  I  must  confess  it  was  not  at  my  suggestion,  at  least,  if  not  abso¬ 
lutely  against  my  advice,  that  he  did  so. 

“  He  showed  me  the  Doctor’s  letter  in  reply,  and  placed  in  my  hands  the  reme¬ 
dial  agents  sent  over  to  him  from  America.  Well,  the  letter  and  the  remedies— 
powerful  agents  compressed  into  the  very  smallest  compass— staggered  me  consid¬ 
erably.  Although  an  unsuccessful  practitioner,  if  you  will,  I  knew  quite  enough  of 
my  profession  to  see  and  understand  that  this  American  Doctor  was  a  man  who 
thoroughly  knew  what  he  was  about,  and  that  his  practice  was  really  based  upon 
the  great  sound  principle  of  Common  Sense.  My  young  friend  recovered  speedily 
and  completely  under  Dr.  Foote’s  treatment  by  correspondence.  It  is  a  homely  old 
saying  that  the  proof  of  the  pudding  is  in  the  eating.  Dr.  Foote’s  success  in  this 
case  impressed  me  rather  favorably;  it  even  led  me  to  advise  some  other  suffering 
friends  of  mine  to  apply  to  the  New  York  Doctor.  The  result  was  equally  favor¬ 
able  in  every  case. 

“ I  now  for  the  first  time  procured  a  copy  of  Dr.  Foote's  ‘Plain  Home  Talk,’ 
and  read  it  carefully  through— indeed,  over  and  over  again— and  the  more  and  the 
oftener  I  perused  the  Doctor’s  ‘Plain  Home  Talk1  upon  Disease  and  its  causes, 
prevention,  and  cure,  the  stronger  the  impression  grew  on  my  mind  that  here  I  had 
met  at  last  with  a  true  healer— an  effective  redresser  of  Nature’s  wrongs.  This 
impression  was  confirmed  and  strengthened  when  I  had  the  much-coveted  pleas¬ 
ure  of  meeting  Dr.  Foote  face  to  face,  and  conversing  with  him  exhaustively  upon 
the  subject  dearest  to  his  heart,  and  engrossing  all  his  thoughts,  faculties,  and 
talents :  the  relief  of  human  suffering.  This  was  some  years  ago,  upon  the  occasion 
of  a  visit  which  the  Doctor  made  to  the  ‘  old  country.’ 

“  It  was,  in  a  great  measure  at  least,  upon  my  advice  that  Dr.  Foote  decided 
to  publish  a  special  edition  of  his  ‘  Plain  nome  Talk  1  for  the  use  and  guidance  of 
Englishmen  and  Englishwomen— which  I  now  beg  leave  to  introduce  to  the  fair 
notice  of  the  British  Public,  fully  convinced  that  all  who  will  read  the  book  with  a 
candid  mind  and  unbiased  judgment,  and  with  the  honest  intention  of  profiting  to 
the  fullest  extent  by  the  sage  lessons  and  sound  advice  upon  the  most  important 
questions  of  life  and  health,  so  intelligently  and  exhaustively  conveyed  in  every 
chapter  of  the  work,  will  reap  a  rich  reward. 


ADVERTISEMENTS. 


“‘Plain  Home  Talk  ’  may  fairly  be  described  as  a  veritable  ‘  Enchiridion  Medi- 
oum;  ’  a  Compendium  of  sound  advice  upon  the  preservation  of  health  and  the 
proper  treatment  of  every  ill  and  ailment  our  poor  human  flesh  is  heir  to,  conveyed 
in  plain  homely  language  that  addresses  itself  with  straightest  directness  to  the 
clear  intelligence  and  understanding  of  all  sensible  men  and  women. 

“  From  the  first  line  of  the  Author’s  own  Preface  to  the  last  passus  in  the  book, 
the  work  is  replete  with  the  very  highest  sense,  Common  Sense,  to  wit,  that  most 
desirable  commodity  which  the  Author  truly— albeit  somewhat  bitterly  perhaps— 
declares  to  be  held  at  a  discount,  especially  in  the  profession  of  Physic,  where 
everything  is  proverbially  ignored  that  has  not  the  mustiness  and  dustiness  of 
antiquity  and  incomprehensibility  to  recommend  it  to  the  favorable  notice  of  the 
‘learned.’  The  Author  proceeds  to  characterize,  rather  felicitously  I  think,  med¬ 
ical  works  in  general  as  heterogeneous  compounds  of  vague  ideas  and  equally 
vague  jaw-breaking,  words,  in  which  the  dead  languages  are  largely  employed  to 
treat  of  living  subjects.  Progress,  says  Dr.  Foote,  is  fully  admitted  to  be  possible 
and  real  in  every  branch  of  art  and  science  and  human  lore— except  in  Medicine, 
in  which  it  would  appear  the  beaten  old  track  must  be  stolidly  pursued,  although 
it  has  been  over  and  over  again,  even  superabundantly,  proved  and  demonstrated 
to  the  meanest  capacity,  that  the  beaten  old  track  is  altogether  the  wrong  road, 
and  leads  to  perdition.  Ay,  he  who  would  strike  out  a  new  path  for  himself  runs 
the  risk  of  being  dubbed  by  staid  medical  orthodoxy  an  empiric— if  not  an  impu¬ 
dent  and  ignorant  quack  I  However,  the  dread  of  this  has  clearly  no  terror  for  Dr. 
Foote,  who  says  he  is  content  to  bear  the  vaporing  denunciation  of  antiquated, 
unreasoning,  and  unreasonable  Medical  Bigotry.  He  cares  not  for  personal  renown 
or  popularity.  His  chief  aspiration  is  to  strive  to  promote  to  the  best  of  his  ability 
and  power  the  physical  and  moral  well-being  of  the  great  human  family.  In  his 
‘Plain  Home  Talk  ’  he  has  endeavored  to  give  to  the  world  a  Medical  Work  treat¬ 
ing  with  equal  thoroughness  of  first  causes  and  ultimate  effects ,  and  of  all  inter¬ 
mediate  facts  and  circumstances  bearing  upon  them,  and  written  in  language 
strictly  mundane,  and  comprehensible  to  all  alike. 

“Many  of  the  theories  which  Dr.  Foote  advances  in  this  work  are  certainly 
new,  and  occasionally  rather  startling.  I  must  candidly  admit  that  some  of  his 
notions  do  not  run  on  all  fours,  as  the  common  saying  has  it,  with  my  own  most 
cherished  ideas  on  the  same  matters,  though  I  do  not  think  I  am  fairly  open  to  the 
taunt  of  old  fogyism.  However,  as  the  Doctor  avouches  that  all  his  views  and  theo¬ 
ries  are  founded  upon  close  observation  and  careful  experiment,  and  an  extensive 
successful  medical  practice,  I  say  over  again  the  proof  of  the  pudding  is  in  the 
eating,  and  objections  based  merely  upon  divergent  theories  should  not  be  urged 
in  opposition. 

“There  is  one  passage  in  the  Doctor’s  own  Preface  to  his  book  in  which  I  go 
along  with  the  author  to  the  very  fullest  extent.  He  says,  ‘  It  may  sound  boastful 
in  a  medical  man  to  parade  his  great  success  in  the  practice  of  his  art  before  the 
public,’  but,  he  thinks  ‘  it  is  as  fair  and  proper  in  him  to  do  so  as  it  is  in  a  military 
chieftain  to  flash  his  achievements  on  the  held  of  battle,  and  the  long  array  of 
orders  he  has  received  in  reward  for  his  skill  and  prowess,  in  the  eyes  of  an  admir¬ 
ing  and  applauding  people.’  This  remark  is  true  to  triteness.  I  go  further— I 
maintain  that  as  by  universal  assent  it  is  so  inuch  more  honorable,  and  certainly 
so  much  more  beneficial  to  mankind,  to  fight  fell  death  and  combat  feller  disease, 
and  prevent  loss  of  limb,  and  restore  the  maimed  and  lamed  to  power  and  action, 
than  to  slay  and  slash— the  true  healer  has  so  much  more  reason  to  exhibit  his 
sigh-board,  as  dear  Artemus  used  to  have  it ;  nay,  it  seems  to  be  his  bounden  duty  to 
his  suffering  fellow-men  to  do  this,  that  they  may  know  where  to  apply  for  relief. 

“In  conclusion  I  have  to  say  a  few  words  on  a  delicate  subject  which  requires 
delicate  handling. 


I234 


ADVERTISEMENTS. 


“Dr.  Foote  in  his  ‘Plain  Home  Talk’  treats  of  all  parts,  organs,  and  functions 
of  the  human  body  alike,  and  of  the  derangements  to  which  they  are  liable — which 
surely,  to  any  man  of  plain  understanding  and  average  intellect,  would  seem  to  be 
the  only  Common  Sense  way  in  a  professedly  medical  work  on  the  preservation  of 
health,  and  the  prevention  and  cure  of  diseases. 

“There  are  two  sets  of  organs  and  functions  in  the  human  body— the  one 
devoted  more  especially  to  the  preservation  of  the  individual,  the  other  more  ex¬ 
clusively  to  the  preservation  of  the  species.  Both  sets  are  equally  important,  one 
would  think,  or  if  there  be  a  difference  of  degree,  it  surely  must  be  held  to  prepon¬ 
derate  on  the  side  of  the  latter.  Yet,  strange  to  say  perhaps,  a  somewhat  tyran¬ 
nical  custom,  based  upon  spurious  shamefacedness,  or  an  overwrought  sense  of 
innate  modesty,  has,  to  a  great  extent  at  least,  placed  all  allusions  to  things  more 
or  less  immediately  connected  with  this  latter  set  under  a  kind  of  social  taboo. 
I  know  this  is  treading  on  dangerous  ground.  I  will  therefore  content  myself  here 
with  referring  the  reader  of  ‘  Plain  Home  Talk  ’  to  Dr.  Foote’s  reasons,  as  stated  in 
his  own  preface,  why  he  has  made  no  marked  distinction  in  his  book  between  the 
treatment  severally  of  the  two  sets.  I  may  perhaps  be  permitted,  however,  to 
append  a  single  remark  : 

“  Parents  living  in  a  city  with  dirty  and  dangerous  back-slums  in  and  about  it, 
will,  if  endowed  with  an  ordinary  share  of  Common  Sense,  surely  endeavor  to  the 
best  of  their  ability  to  instruct  their  children,  who  may  at  some  time  or  other  have 
to  pass  through  such  objectionable  places,  as  to  their  nature,  and  to  warn  them 
against  the  danger  lurking  in  them.  Yet  will  they,  from  mistaken  delicacy  and 
shame,  send  forth  their  children  on  their  way  through  the  infinitely  more  danger¬ 
ous  back-slums  of  life,  without  instruction,  without  warning.” 


A  Physician  of  a  Broad  Education  writes  from  Ilambrook  Court , 

England. 

“  Dear  Sir  :  I  was  in  Bristol  a  few  days  ago,  and  when  at  a  bookstall  I  saw 
your  remarkable  book  entitled  ‘Plain  Home  Talk,’  I  began  to  read, but  could  not 
put  down  the  book  till  it  was  read  through.  Although  a  hard  student  for  fifty 
years,  I  have  met  with  much  that  was  new,  startling,  and  very  instructive.  If 
every  adult  in  the  civilized  world  could  read,  understand,  and  would  follow  out 
your  views,  in  a  few  generations  there  would  be  a  world  of  physical,  intellectual, 
and  moral  giants.  Your  work  is  priceless  in  value  and  calculated  to  regenerate 
society. 

“  If  there  is  anything  you  think  I  should  like  to  have  in  tract-form,  please  send 
it.  I  have  lately  retired  from  practice,  and  am  ready  for  anything  In  advance. 
Believe  me,  fraternally  yours,  S.  Eadon,  M.  A..  M.D.,  Ph.D .,  F.S.A.,  Grad,  of  Med. 
of  Edinburgh ,  Glasgow ,  and  Aberdeen.'" 


A  Physician' s  Honest  Opinion. 

Philadelphia,  Pa. 

“  Dear  Sir  :  I  have  carefully  read  your  book  ‘  Plain  Home  Talk  and  Medical 
Common  Sense,’  and  as  I  am  myself  a  physician,  and  also  have  given  a  good  deal 
of  attention  to  social  science  and  kindred  studies,  I  feel  competent  to  judge  of  it. 
I  was  strongly  prejudiced  against  all  publications  of  the  kind  I  thought  this  to  be. 
But  now  I  must,  as  an  honest  man,  say  to  you  that  your  book  is  an  able,  honest, 
and  truthful  presentation  of  facts  and  theories,  and  calculated  to  do  much  good. 
I  thank  you  for  it.  You  may  use  this  letter,  as  I  mean  what  I  say  and  am  not 
ashamed  to  say  it. 


Your  obedient  servant, 


Louis  Seymour.” 


OPINIONS  OF  THE  PEOPLE. 


1239 


Beats  them  All. 

“I  secured  a  copy  of  your  wonderful  book,  ‘Plain  Home  Talk.’  Never  did 
Scott,  Thackeray,  or  Dickens  claim  such  attention  from  me  as  did  your  book. 
Not!  ,n g  that  has  ever  been  written  equals  it. 

“Yours  truly,  Mrs.  Jessie  P.  Hall,  Stevenson,  Ala.” 


Should  be  Read  Early  in  Life. 

“  ‘  Plain  Home  Talk  ’  is  very  full,  and  I  have  been  much  interested,  and  only 
regret  that  at  an  earlier  period  of  life  I  was  not  made  acquainted  with  many  of 
the  physical  facts  which  you  mention.  I  quite  think  with  you,  that  there  is  by  far 
too  much  reticence  displayed  by  parents  as  regards  the  evils  to  which  many  of  the 
young  are  liable.  I  thank  you  for  your  good  work. 

“Yours  faithfully,  John  B.  H.  Gandy,  Sheffield,  England.” 


Gained  a  Great  Beal  of  Information. 

“  I  became  possessed  of  your  ‘  Plain  Home  Talk  1  a  little  while  ago,  and  I  have 
perused  its  pages  with  much  interest  and  benefit.  I  have  gained  therefrom  a 
great  deal  of  information  upon  matters  of  which  I  was  almost  entirely  ignorant 
before  I  purchased  your  valuable  work. 

“Yours  very  truly,  A.  R.  Whitelock,  New  York  City.” 


Didn’t  Know  a  Doctor  had  so  much  Horse  Sense. 

“  Have  a  copy  of  your  ‘  Plain  Home  Talk.’  Didn’t  know  a  doctor  had  so  much 
horse  sense.  Thought  they  were  full  of  high-flying  words.  Seriously,  it  is  a  great 
book,  and  the  author  is  a  great  man.  Why  !  if  the  house  caught  fire,  I  would  run 
for  that  book  as  soon  as  I  got  the  insurance  policy. 

“  Yours  truly,  Watson  A.  Conover,  Freehold,  N.  J.” 


Brimming  Over  with  Useful  Knowledge. 

“  A  short  time  ago  I  received  one  of  your  books,  ‘  Plain  Home  Talk,’  and  I  am 
very  much  pleased  with  it.  It  is  brimming  over  with  useful  knowledge,  and  is  a 
book  needed  in  every-day  practical  life. 

“Respectfully  yours,  Charles  Wiler,  Argyle,  Minn.” 


Would  not  be  Without  it. 

“I  have  read  ‘Plain  Home  Talk  and  Medical  Common  Sense’  and  am  well 
pleased  with  it ;  would  not  be  without  it  now.  I  only  regret  that  I  did  not  get 
one  the  first  time  I  saw  it  advertised.  Will  show  and  recommend  it  to  friends  who 
take  an  interest  in  Common  Sense  and  welfare  of  human  mind  and  body.  I  thank 
you  for  the  one  that  happened  to  fall  into  my  hands. 

“  Yours  very  truly,  Geo.  A.  Zimmerman.” 


A  FEW  EXPLANATORY  WORDS. 

N.  B.  The  reader  will  please  remember  that  the  above  letters  (; merely  samples 
of  thousands  received)  refer  to  the  editions  of  '’'‘Plain  Hon\e  Talk ”  published  not 
long  before  1900.  During  that  year  the  great  revision  was  made ,  adding  several 
hundred  new  pages ,  many  neio  cuts ,  and  eight  new  color  plates,  all  of  which  now 
appear  in  thecomplete  work ,  “ Dr .  Foote's  Home  Cyclopedia."  In  short  the  book  which 
was  so  generally  satisfactory  to  all  sorts  of  people,  has  been  made  new  all  through , 
still  more  complete  and  even  “  better  than  the  best." 


1240 


ADVERTISEMENTS. 


THE 

MURRAY  HILL  SERIES! 


AN  AMUSING  STORY, 

IN  WHICH 

Dr.  Foote,  Author  of  Plain  Home  Talk,  etc., 

TEACHES  ANATOMY,  PHYSIOLOGY,  and  HYGIENE. 

A  series  for  the  young ,  the  middle-aged ,  the  old,  and  everybody  ! 

-  / 

Five  Volumes,  containing  in  all  over  1,200  pages  and  400  Comic  and 

Scientific  Illustrations  1 ! 

This  series  bears  the  name  of 

“SCIENCE  IN  STORY; 

OR, 

Sammy  Tubbs  the  Boy-Doctor,  and  Sponsie  the  Troublesome  Monkey.” 

CHILDREN  ARE  CARRIED  AWAY  WITH  IT, 

AND  THE  OLDER  ONES  ARE  SPLITTING  THEIR  SIDES 

While  reading  it,  and  learning  more  than  they  ever  before  thought  of  respecting 
the  curious  mechanism  of  their  own  bodies  !  ! 

Buy  it  for  yourself  ;  obtain  it  for  your  children  ;  for,  while  being  amused  and 
entertained  with  the  progress  of  Sammie  and  the  laughable  tricks  of  Sponsie,  you 
will  be  acquiring  the  most  valuable  information  ever  presented  about  the  con¬ 
struction  and  marvellous  workings  of  the  vronderful  organs  which  enable  you  to 
live  and  move  upon  the  earth  as  an  animate  and  human  being. 

The  work  is  mainly  sold  by  agents,  but  it  may  be  had  directly  of  the  Publishers 
if  no  agents  are  selling  it  in  your  neighborhood. 

RETAIL  PRICES. 

Extra  Cloth,  inked  back  and  sides,  in  set  of  five  volumes,  -  $2.50  per  vol. 

Tinted  paper,  red  lined,  extra  English  cloth,  bevel  boards, 
gold  side  and  back,  red  edges,  just  the  thing  for  Holi¬ 
day  and  Birthday  Presents,  in  set  of  five  volumes,  -  5.00  “ 

The  five  vols.  in  one,  on  light  paper,  neatly  bound,  ONLY,  -  -  $2.00 

Agents  Wanted  for  the  sale  of  the  Murray  Hill  Series.  Teachers,  and 
especially  lady  teachers,  have  unusual  facilities  for  selling  this  wTork  with  benefit 
to  their  pupils  and  profit  to  themselves.  Call  on  or  address 

MURRAY  HILL  PUBLISHING  COMPANY, 

129  East  28th  Street ,  JT, 


ADVERTISEMENTS. 


124  T 


“SCIENCE  IN  STORY;” 

Or,  “Sammy  Tubbs  the  Boy-Doctor  arid 
Sponsie  the  Troublesome  Monkey,” 

Advertised  on  the  preceding  page,  is  a  most  attractive,  original,  and  novel  publica¬ 
tion  from  the  pen  of  Dr.  Foote.  Stop  a  moment  and  give  a  hasty  glance  to  the 
subjects  of  each  volume. 

VOLUME  I. 

Gives  a  history  of  Sammy’s  beginnings  ;  of  Sponsie’s  arrival  in  this  country,  and  of 
his  invaluable  services  as  a  companion  of  the  Boy-Doctor.  It  also  imparts  a  clear 
knowledge  of  how  the  frame  of  the  human  body  is  put  together  and  held  together 
by  Cartilages,  Tendons,  and  Muscles. 

VOLUME  II. 

Is  humorous  with  April-fool  jokes,  fantastics,  monkey-tricks,  etc.,  and  instructive 
in  matter  relating  to  the  Arteries,  Veins,  Capillaries,  Lymphatics,  Lacteal  Radicles, 
Villi,  and  all  that  appertains  to  circulation  and  absorption. 

VOLUME  III. 

Shows  how  a  mischievous  animal  can  turn  a  well-regulated  household  upside-down 
with  his  sly  and  cunning  tricks.  It  is  irresistibly  funny,  and  at  the  same  time  it 
gives  the  reader  a  clear  idea  in  regard  to  the  way  in  which  Digestion,  Nutrition, 
and  Respiration  are  performed. 

VOLUME  IV. 

Gives  an  account  of  Sammy’s  first  lecture,  the  masked  party  at  the  Biddlewicker’s, 
the  two  monkey-soldiers,  and  the  tragedy  of  Shin-bone  Alley  ;  and  it  gives  facts 
and  theories  of  great  interest  respecting  the  Brain  and  Nerves.  Everything  in  it 
is  plain  to  those  who  have  attentively  read  the  preceding  three  volumes.  Each 
volume  prepares  the  reader  for  the  next. 

VOLUME  V. 

Treats  upon  the  Eliminative  and  Reproductive  Organs,  and  reopens  the  story 
which  seems  to  close  with  Vol.  IV.  This  is  the  most  valuable  and  instructive  of 
the  whole  series  ;  but  parents  who  do  not  think  it  best  to  give  their  children  this 
most  important  information,  are  at  liberty  to  withhold  it  from  them. 

EACH  VOLUME 

Contains  256  pages,  although  the  folios  in  some  of  them  do  not  run  so  high  in  con¬ 
sequence  of  full-page  pictures,  which  are  not  counted  in  the  numbering.  Each 
one  is  handsomely  illustrated  with  comic  pictures  from  the  experienced  hand  of 
II.  L. "Stephens,  Esq.  The  illustrations  are  copied  on  plates  from  original  pen- 
and-ink  designs,  making  the  series  a  novelty  in  art  as  well  as  in  matter.  The 
reader  is 

INSTRUCTED  AS  WELL  AS  AMUSED 

And  interested  in  the  perusal  of  this  remarkable  series.  Everybody  likes  it,  and 
everybody  is  buying  it. 

55^ A  full  contents  table  will  be  sent  free  to  all  interested  parties  who  prefer 
to  examine  the  summary  of  contents  before  ordering  the  series.  Copies  sent, 
postage  prepaid,  on  receipt  of  the  price.  Neat  Cloth  binding,  per  volume,  50  cents. 
Gold  embossed,  red  line,  red  edges,  $1.00  per  volume.  (Sold  only  in  sets.)  The  five 
volumes  in  one,  on  light  paper,  neatly  bound,  in  Black  Cloth,  only  $2.00. 

Agents  Wanted  for  this  series  and  for  Dr.  Foote’s  other  publications.  Car. 
on  or  address  Murray  Hill  Publishing  Company.  129  East  2Cth  Street.  New  York. 


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With  Tocology  for  Mothers,  is  made  up  of  the  last  400  pages  of  Dr.  Foote’s 
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TOCOLOGY  FOR  MOTHERS, 

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DR.  FOOTE’S  OFFENE  VOLKS=SPRACHE 

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SCIENCE  IN  STORY ;  or  Sammy  Tubbs,  the  Boy  Doctor,  and 
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SEXUAL  PHYSIOLOGY  FOR  THE  YOUNG ; 

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HAND  BOOK  OF  HEALTH  HINTS 

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WONDERS,  FREAKS  AND  DISEASES, 

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REPLIES  TO  ALPHITES, 

The  pro  and  the  con  of  sexual  continence— a  debate;  128  pages.  25c. 
DIVORCE,  A  lecture  by  Dr.  Foote,  and  extracts  from  noted  authors.  25c. 
COMHON  SENSE  CARE  OF  CANARIES, 

By  Mrs.  Farwell.  Color  cover.  50c. 

HOW  TO  flESriERIZE,  By  James  Coates,  Ph.  D.  Plain  instruction;  50c. 
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